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https://doi.org/10.1177/1359105318765621
Journal of Health Psychology
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DOI: 10.1177/1359105318765621
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Burnout has been defined as a long-term affec-
tive state consisting of physical fatigue, cogni-
tive weariness, and emotional exhaustion and
resulting from unresolvable job stress (Shirom
and Melamed, 2006). To date, burnout has
become a focal object of investigation in occu-
pational health research (Maslach et al., 2001).
However, many gray areas surround the con-
struct. A nodal point of debate in the literature
concerns the extent to which burnout reflects
anything other than a depressive condition
(Bianchi et al., 2017). Indeed, there has been
mounting evidence that burnout overlaps with
depression at a symptom and an etiological
level (e.g. Bianchi and Brisson, 2017).
In recent years, occupational health research-
ers have started to examine the burnout–depres-
sion distinction in terms of the cognitive
processing of emotional information. Within
this subfield of research, burnout has been
related to increased attention for dysphoric stim-
uli and decreased attention for positive stimuli,
an attentional pattern that is typical of depres-
sion (Bianchi and Laurent, 2015; De Raedt and
Koster, 2010). In addition, burnout has been,
like depression, associated with dysfunctional
attitudes (e.g. pathological perfectionism and
need for approval), ruminative responses, and
pessimistic attributions (Beck, 2008; Bianchi
and Schonfeld, 2016; Rubenstein et al., 2016).
Although growing, research on how individuals
Memory bias toward emotional
information in burnout and
depression
Renzo Bianchi1, Eric Laurent2, Irvin Sam Schonfeld3,
Lucas M Bietti1 and Eric Mayor1
Abstract
A sample of 1015 educational staff members, exhibiting various levels of burnout and depressive symptoms,
underwent a memory test involving incident encoding of positive and negative words and a free recall
task. Burnout and depression were each found to be associated with increased recall of negative items and
decreased recall of positive items. Results remained statistically significant when controlling for history of
depressive disorders. Burnout and depression were not related to mistakes in the reported words, or to
the overall number of recalled words. This study suggests that burnout and depression overlap in terms of
memory biases toward emotional information.
Keywords
burnout, cognition, depression, emotion, memory bias, stress
1University of Neuchâtel, Switzerland
2Bourgogne Franche-Comté University, France
3The City University of New York, USA
Corresponding author:
Renzo Bianchi, Institute of Work and Organizational
Psychology, University of Neuchâtel, Émile-Argand 11,
2000 Neuchâtel, NE, Switzerland.
Email: dysangile@gmail.com
765621HPQ0010.1177/1359105318765621Journal of Health PsychologyBianchi et al.
research-article2018
Article
2 Journal of Health Psychology 00(0)
with burnout symptoms process emotional
information is still in its infancy. To our knowl-
edge, no study investigated emotional memory
in burnout thus far.
The aim of this study was to examine
whether burnout parallels depression in terms
of memory biases toward emotional informa-
tion. As observed by Gotlib and Joormann
(2010), “preferential recall of negative com-
pared to positive material is one of the most
robust findings in the depression literature” (p.
292), especially when free recall tasks, involv-
ing explicit memory, are used (see also Everaert
et al., 2014). Along with other cognitive altera-
tions (e.g. at attentional and interpretational
levels), memory biases are thought to play a
role in the onset, maintenance, and recurrence
of depression (Laurent et al., 2018; Sanchez
et al., 2017). Based on the finding that burnout
and depression overlap in terms of symptoma-
tology and etiology (Bianchi et al., 2018), we
hypothesized that individuals with burnout
symptoms would exhibit biased memory for
negative, over positive, information. Better
understanding the cognitive alterations that
characterize burnout is important both from a
theoretical standpoint (e.g. for determining
whether the burnout construct refers to a phe-
nomenon that is different from depression) and
a practical standpoint (e.g. to design effective
prevention and treatment strategies).
Methods
Study sample and recruitment
procedure
A convenience sample of 1015 French educa-
tional staff, employed in the areas of Amiens
and Grenoble, was recruited for the purpose of
this study (89% female). The sample comprised
teachers (83%), professionals having both
teaching and supervisory charges (7%), admin-
istrators (6%), and administrative assistants
(1%). The remaining participants were working
as education assistants, education advisers,
school psychologists, accountants, and school
nurses.
Participants were reached by email through
contacts with nearly 6000 schools in November
and December 2017. The only eligibility crite-
rion for participating in the study was to be cur-
rently employed as an educational staff member
in an elementary school, a middle school, or a
high school. Educational staff, most notably
teachers, have been found to be exposed to
adverse work environments and are often mobi-
lized in research on burnout and depression
(Maslach et al., 2001; Schonfeld, 2001).
Cognitive biases are particularly worth examin-
ing among such professionals given the rela-
tional aspect of their work and the potential
impact of cognitive biases on variables such as
students’ assessment (e.g. Brackett et al., 2013).
Participants took part in a web-based study,
designed and administered with Qualtrics®.
Web-based studies have been shown to be
methodologically viable and particularly useful
to ensure satisfactory statistical power
(Birnbaum, 2004; Gosling et al., 2004; Horton
et al., 2011). Participation was entirely volun-
tary. Confidentiality was guaranteed to each
participant. Respondents were informed that,
by completing the survey, they were giving
consent to their inclusion in the study.
Participants’ mean age was 40.88 years (stand-
ard deviation (SD) = 9.41), with a mean length
of employment of 14.38 years (SD = 9.48).
We note that our recruitment procedure did
not allow us to estimate the response rate to our
study. Indeed, while the number of contacted
schools was known, we had no information on
the number of educational staff members who
got actual access to our study.
Self-report measures
The Shirom-Melamed Burnout Measure
(SMBM; Shirom and Melamed, 2006) was used
for assessing burnout symptoms (Cronbach’s
α = 0.92). The SMBM consists of three sub-
scales, namely, physical fatigue (six items; e.g.
“I feel physically drained.”), cognitive weari-
ness (five items; e.g. “My thinking process is
slow.”), and emotional exhaustion (three items;
e.g. “I feel I am unable to be sensitive to the
Bianchi et al. 3
needs of coworkers and students.”). Respondents
reported the symptoms experienced over the
past 2 weeks using a 4-point scale (from 1 for
“not at all” to 4 for “nearly every day”). A prin-
cipal axis factor analysis (PFA) with promax
rotation was conducted to reexamine the struc-
ture of the SMBM. Three factors emerged from
the PFA, corresponding to the physical fatigue,
cognitive weariness, and emotional exhaustion
subscales of the questionnaire (explained vari-
ance: 68%; Kaiser-Meyer-Olkin measure of
sampling adequacy = 0.92; Bartlett’s test of
sphericity: p < 0.001). In contrast with other
measures of burnout such as the Maslach
Burnout Inventory (Maslach et al., 2001), the
SMBM is in the public domain and reflects a
theory-based and conceptually homogeneous
view of burnout (Brisson and Bianchi, 2017;
Schears, 2017; Shirom and Melamed, 2006).
Depressive symptoms were assessed with
the PHQ-9 (Kroenke et al., 2001; Cronbach’s
α = 0.82). The items of the PHQ-9 target each of
the nine diagnostic criteria for major depressive
disorder (e.g. anhedonia, depressed mood) of
the Diagnostic and Statistical Manual of Mental
Disorders, fifth edition (American Psychiatric
Association, 2013). Respondents employed a
4-point scale (from 1 for “not at all” to 4 for
“nearly every day”). Participants’ symptoma-
tology was examined over the past 2 weeks.
A PFA with promax rotation revealed a two-
factor structure, corresponding to the cogni-
tive–affective symptoms of depression on the
one hand, and the somatic symptoms of depres-
sion on the other hand (explained variance:
40%; Kaiser-Meyer-Olkin measure of sampling
adequacy = 0.87; Bartlett’s test of sphericity:
p < 0.001). Similar results were found in a fac-
tor-analytic study of the PHQ-9 conducted
among psychiatry patients (Beard et al., 2016).
Participants were additionally asked to report
their age, sex, occupation, length of employ-
ment, and history of depressive disorders. This
latter variable was assessed with the following
item: “Have you ever been diagnosed for a
depressive disorder by a health professional
(e.g. a general practitioner, a psychiatrist, a psy-
chologist)? Answer ‘Yes’ only if this diagnosis
has resulted in treatment with medication and/or
psychotherapeutic treatment.” The second part
of the item was intended to limit the risk of
false-positive report.
Memory test
Participants underwent a memory test involving
incident encoding and an immediate free recall
task (Gotlib and Joormann, 2010; Turk-Browne
et al., 2006). Participants were presented with
10 positive words and 10 negative words
adapted from the Positive and Negative Affect
Schedule (Gaudreau et al., 2006; Watson et al.,
1988).1 Participants were only instructed to
silently read each of the words displayed. Each
word was displayed for 3 seconds. Word pres-
entation was randomized. The mean number of
syllables was 2.5 for both positive and negative
words. Right after the word presentation, the
participants were requested to recall as many
words as possible. They were given 1 minute to
read the recall task instructions and write down
the recalled words. The memory test was placed
at the beginning of the protocol in order to
avoid possible interferences with the other
materials used in the study (e.g. the words con-
tained in the SMBM and the PHQ-9).
Data analyses
We examined the relationships among our vari-
ables of interest using bivariate and partial cor-
relation analyses, Student’s t test, Pearson’s
chi-square test, Fisher’s exact test, multivariate
analysis of variance (MANOVA), and multi-
variate analysis of covariance. Seven depend-
ent variables were defined on the basis of the
memory test: the number of recalled positive
words; the number of recalled negative words;
the percentage of recalled positive words; the
percentage of recalled negative words; the
number of mistakes (reported words that were
not in the presented list); the percentage of mis-
takes; and the overall number of recalled items.
With the objective of comparing individuals
scoring at the lower and upper ends of the burn-
out and depression continua, we created a “low
4 Journal of Health Psychology 00(0)
depression,” a “high depression,” a “low burn-
out,” and a “high burnout” group. As a reminder,
burnout and depression were both assessed
using a 4-point scale ranging from 1 for “not at
all” to 4 for “nearly every day.” The “low
depression” group was defined by a PHQ-9
mean score < 2, whereas the “high depression”
group was defined by a PHQ-9 mean score ≥ 3.
On a similar basis, the “low burnout” group was
defined by an SMBM mean score < 2, whereas
the “high burnout” group was defined by an
SMBM mean score ≥ 3. Thus, the “low depres-
sion” and “low burnout” groups included indi-
viduals who seldom, if ever, experienced
symptoms over the past 2 weeks—symptoms
experienced less than several days—whereas
the “high depression” and “high burnout”
groups included individuals who experienced
symptoms more than half the days over the past
2 weeks (i.e. individuals with rather pervasive
symptoms). By assessing burnout and depres-
sion with identical response options and catego-
rizing burnout and depression on the basis of
identical cut-points, we were able to compare
burnout and depression in a consistent fashion.
In order to classify the words reported by our
participants during the memory test, we con-
ducted an automatic content analysis with
LWIC2007 (Pennebaker et al., 2007), using a
custom dictionary (positive terms: intéressé,
excité, fort, enthousiaste, fier, vif, inspiré, déter-
miné, attentif, and actif; negative terms: ango-
issé, fâché, coupable, effrayé, hostile, irritable,
honteux, nerveux, agité, and apeuré). For veri-
fication purposes, inter-rater agreement with a
human coder was examined for a quarter of the
corpus. A 100 percent agreement was obtained.
Results
Correlations among the main study
variables
Bivariate correlations among the main study
variables are displayed in Table 1. Burnout was
found to correlate strongly with depression,
r = 0.73, p < 0.001 (disattenuated correlation:
0.84). Burnout and depression each correlated
Table 1. Means (M), standard deviations (SD), and zero-order correlations among the main study variables (N = 1015).
M SD 2 3 4 5 6 7 8 9 10 11 12 13
1 Depressive symptoms (1–4) 1.73 0.53 0.73 –0.15 0.19 –0.25 0.24 0.04 0.01 –0.04 –0.02 –0.03 –0.04 0.18
2 Burnout symptoms (1–4) 1.92 0.60 – –0.18 0.18 –0.26 0.25 0.05 0.04 0.02 0.04 –0.05 0.04 0.14
3 Recalled positive words (n) 3.53 1.42 – –0.00 0.71 –0.43 –0.02 –0.37 0.06 –0.12 –0.08 –0.09 –0.03
4 Recalled negative words (n) 2.97 1.42 – –0.52 0.81 0.01 –0.34 0.02 –0.13 –0.02 –0.06 0.07
5 Recalled positive words (%) 49.30 16.78 – –0.69 –0.02 –0.42 0.06 –0.01 –0.05 –0.03 –0.06
6 Recalled negative words (%) 40.75 16.42 – 0.00 –0.37 –0.01 –0.04 0.02 –0.01 0.09
7 Mistakes (n) 0.70 0.93 – 0.02 0.12 0.03 –0.02 –0.05 0.01
8 Mistakes (%) 9.95 13.18 – –0.06 0.07 0.03 0.05 –0.04
9 Total word count (n) 7.20 1.89 – –0.00 0.02 0.00 –0.02
10 Age (in years) 40.88 9.41 – 0.06 0.80 0.13
11 Sex (0/1) 0.11 0.32 – 0.03 –0.06
12 Length of employment (in years) 14.38 9.48 – 0.10
13 History of depressive disorders (0/1) 0.29 0.45 –
Italicized correlation coefficients are significant at p < 0.05. Sex was coded 0 for “female” and 1 for “male.” History of depressive disorders was coded 0 for “absent” and 1 for “present.”
Bianchi et al. 5
(a) negatively with the number and the percent-
age of recalled positive words and (b) positively
with the number and the percentage of recalled
negative words. Burnout and depression were
not associated with mistakes in the reported
items, the overall number of recalled items, or
any of the other variables under consideration
except history of depressive disorders. The cor-
relations of burnout and depression with the
recalled emotional words remained statistically
significant, and almost unchanged, when his-
tory of depressive disorders was controlled for.
“Low depression” group versus “high
depression” group
The characteristics of the depression-related
groups are presented in Table 2. A first
MANOVA showed an effect of group member-
ship on the number of recalled positive and
negative words, Pillai’s Trace = 0.03, F(2,
740) = 10.35, p < 0.001 (Box’s M = 1.33,
p = 0.73). Participants in the “low depression”
group recalled (a) a greater number of positive
words (M = 3.65, SD = 1.40) than participants in
the “high depression” group (M = 2.67,
SD = 1.24), Cohen’s d = 0.74, and (b) a smaller
number of negative words (M = 2.82, SD = 1.39)
than participants in the “high depression” group
(M = 3.50, SD = 1.33), Cohen’s d = 0.50. The
effect of group membership on the number of
recalled positive and negative words remained
statistically significant when history of depres-
sive disorders was introduced as a covariate
(effect size reduced by 7%) but not when burn-
out symptoms were controlled for (F(2,
739) = 1.65, p = 0.19).
A second MANOVA revealed an effect of
group membership on the percentage of recalled
positive and negative words, Pillai’s
Trace = 0.03, F(2, 740) = 10.92, p < 0.001 (Box’s
M = 3.81, p = 0.29). Participants in the “low
depression” group recalled (a) a greater per-
centage of positive words (M = 51.44,
SD = 16.98) than the participants in the “high
depression” group (M = 38.36, SD = 14.57),
Cohen’s d = 0.83, and (b) a smaller percentage
of negative words (M = 38.76, SD = 16.54) than
the participants in the “high depression” group
Table 2. Characteristic of the depression- and burnout-related groups.
Depression-related groups Burnout-related groups
“Low depression”
(n = 713)
“High depression”
(n = 30)
“Low burnout”
(n = 603)
“High burnout”
(n = 71)
M SD M SD p value Cohen’s d M SD M SD p value Cohen’s d
Depressive symptoms (1–4) 1.44 0.25 3.23 0.23 <0.001 7.45 1.46 0.34 2.59 0.50 <0.001 2.64
Burnout symptoms (1–4) 1.68 0.45 3.00 0.56 <0.001 2.60 1.51 0.27 3.27 0.24 <0.001 6.89
Age (in years) 41.01 9.28 44.13 9.59 0.07 0.33 40.68 9.47 43.69 8.36 0.01 0.34
Length of employment (in years) 14.54 9.37 15.14 9.56 0.73 0.06 14.09 9.36 16.70 8.41 0.03 0.29
Female sex 88% 73% 0.04 0.38 87% 86% 0.72 0.03
History of depressive disorders 26% 57% <0.001 0.66 25% 46% <0.001 0.45
M: mean; SD: standard deviation.
Between-group comparisons were conducted using Student’s t test and Pearson’s chi-square test. Fisher’s exact test was used with the “female sex” variable in depression-related
groups because one cell (25%) had expected count less than 5 (Field, 2009, p. 692).
6 Journal of Health Psychology 00(0)
(M = 52.31, SD = 15.93), Cohen’s d = 0.83. The
effect of group membership on the percentage
of recalled positive and negative words
remained statistically significant when history
of depressive disorders was introduced as a
covariate (effect size reduced by 10%) but not
when burnout symptoms were controlled for
(F(2, 739) = 1.52, p = 0.22).
We found no effect of group membership on
the number of mistakes (p = 0.89), the percent-
age of mistakes (p = 0.85), or on the total word
count (p = 0.87).
“Low burnout” group versus “high
burnout” group
The characteristics of the burnout-related
groups are presented in Table 2. A first
MANOVA showed an effect of group member-
ship on the number of recalled positive and
negative words, Pillai’s Trace = 0.05, F(2,
671) = 16.04, p < 0.001 (Box’s M = 7.23,
p = 0.05). Participants in the “low burnout”
group recalled (a) a greater number of positive
words (M = 3.73, SD = 1.42) than the partici-
pants in the “high burnout” group (M = 2.90,
SD = 1.33), Cohen’s d = 0.60, and (b) a smaller
number of negative words (M = 2.80, SD = 1.39)
than the participants in the “high burnout”
group (M = 3.38, SD = 1.31), Cohen’s d = 0.43.
The effect of group membership on the number
of recalled positive and negative words
remained statistically significant when history
of depressive disorders was introduced as a
covariate (effect size reduced by 11%) and also
when depressive symptoms were controlled for,
although the effect size was dramatically
reduced (by 80%).
A second MANOVA revealed an effect of
group membership on the percentage of recalled
positive and negative words, Pillai’s
Trace = 0.05, F(2, 671) = 16.35, p < 0.001 (Box’s
M = 6.71, p = 0.08). Participants in the “low
burnout” group recalled (a) a greater percentage
of positive words (M = 52.50, SD = 17.18) than
the participants in the “high burnout” group
(M = 40.95, SD = 14.08), Cohen’s d = 0.74, and
(b) a smaller percentage of negative words
(M = 38.36, SD = 16.88) than the participants in
the “high burnout” group (M = 48.95,
SD = 15.39), Cohen’s d = 0.66. The effect of
group membership on the percentage of recalled
positive and negative words remained statisti-
cally significant when history of depressive dis-
orders was introduced as a covariate (effect size
reduced by 9%) but not when depressive symp-
toms were controlled for (F(2, 670) = 1.32,
p = 0.27).
We found no effect of group membership on
the number of mistakes (p = 0.08), the percent-
age of mistakes (p = 0.56), or the total word
count (p = 0.91).
Discussion
The main aim of this study (N = 1015) was to
examine burnout–depression overlap in terms
of memory biases toward emotional informa-
tion. As predicted, we found that burnout and
depressive symptoms were associated with sim-
ilar mnemonic alterations, consisting in an
under-recall of positive items and an over-recall
of negative items. This study (a) confirms that
negative information outweighs positive infor-
mation in depressed individuals’ memory
(Everaert et al., 2014; Gotlib and Joormann,
2010) and (b) highlights, for the first time, a
similar phenomenon in burnout.
Burnout–depression overlap has been docu-
mented at a nomological network level in many
studies. For instance, burnout and depression
have been found to be similarly associated with
rumination, neuroticism, extraversion, self-
rated health, physical activity, job satisfaction,
job adversity, workplace social support, and
stressful life events (for an overview, see
Bianchi et al., 2018). In Bianchi and Laurent’s
(2015) eye-tracking study, burnout and depres-
sion were related to the same tendency to over-
focus on dysphoric information and to
under-focus on positive information. The
present study suggests that the burnout–depres-
sion overlap extends to emotional memory. The
propensity of individuals with burnout/depres-
sive symptoms to prioritize negative informa-
tion is likely to play a role in symptom
Bianchi et al. 7
maintenance by participating in a self-under-
mining spiral—the more dysphoria one experi-
ences, the more negative memories one
stabilizes, the more dysphoria one experiences,
and so on (Gotlib and Joormann, 2010).
In our study, the overlap of burnout with
depression was also reflected in the strong cor-
relation between the two variables. Associations
of similar magnitudes have been commonly
found when correlating different measures of
burnout or different measures of depression
with each other (Bianchi and Brisson, 2017;
Shirom and Melamed, 2006; Wojciechowski
et al., 2000). Our results are in keeping with the
view that burnout refers to depressive manifes-
tations under a nonmedical label (Bianchi et al.,
2018).
Interestingly, burnout and depressive symp-
toms were not associated with mistakes in the
reported words, or with the overall number of
recalled words. These findings contrast with
those documented in some previous studies (for
reviews, see Deligkaris et al., 2014; Rock et al.,
2014). Our findings, however, are consistent
with the idea that the impairment of executive
functions in burnout and depression is primarily
detectable in the most severe forms of these
conditions (Deligkaris et al., 2014; Snyder,
2013). Although our sample contained individ-
uals with varied levels of burnout and depres-
sive symptoms, these symptoms were still
compatible with the capacity to work and might
not have been severe enough to influence
immediate free recall performance.
At least four limitations to this study should
be mentioned. First, because our study was
cross-sectional, the issue of whether memory
biases are better viewed as risk factors, corre-
lates, or consequences of burnout and depres-
sion could not be addressed (Gotlib and
Joormann, 2010). Second, about 9 of 10 partici-
pants in our study were women, a state of affairs
that bears on the generalizability of our results
to men. This being mentioned, sex showed no
clear association with any of the variables under
scrutiny, suggesting that this imbalance may not
be of major importance. Third, only working
individuals were examined in this study. Studies
involving individuals on sick leave, who may
present with more severe symptoms, would be
useful. Fourth, only one type of memory test
was employed in our study. It would be inform-
ative to employ different types of memory tests
in the future (e.g. delayed recall tasks), in order
to examine other facets of emotional memory in
burnout versus depression.
All in all, our findings suggest that burnout
and depression are associated with similar alter-
ations of emotional memory. Our study pro-
vides additional evidence that individuals with
burnout symptoms view the world with “depres-
sive glasses,” consistent with the idea that burn-
out is a depressive condition.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of inter-
est with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this article.
ORCID iD
Renzo Bianchi https://orcid.org/0000-0003-2336-
0407
Note
1. Positive terms in English: interested, excited,
strong, enthusiastic, proud, alert, inspired, deter-
mined, attentive, and active; negative terms in
English: distressed, upset, guilty, scared, hostile,
irritable, ashamed, nervous, jittery, and afraid.
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