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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.
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Journal of Health Psychology
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DOI: 10.1177/1359105318765621
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
Renzo Bianchi1, Eric Laurent2, Irvin Sam Schonfeld3,
Lucas M Bietti1 and Eric Mayor1
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.
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.
765621HPQ0010.1177/1359105318765621Journal of Health PsychologyBianchi et al.
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).
Study sample and recruitment
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
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.
Correlations among the main study
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).
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.,
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.
The author(s) received no financial support for the
research, authorship, and/or publication of this article.
Renzo Bianchi
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... A study conducted in France examined the association between borderline personality depression and burnout. In females, burnout was associated with the "affective insecurity" and "impulsiveness" components of Borderline Personality [13]. A study conducted in Bahrain evaluated the link between mental illness stigma and evidence-based care provision and showed healthcare professionals who approved acquiring evidencebased practices reflected less stigma directed toward patients with mental illness [14]. ...
... The total is calculated by adding all scores together [13]. Data was collected from January to May 2022 and all the collected data was then checked, cleaned, coded, entered, and statistically analyzed using Statistical Package for Social Science (SPSS) version 21. ...
... Especially for the driver group, length of driving years [22] and working hours [14] were also to be considered [23]. Job burnout was significantly correlated with depression [16,24,25], anxiety [24], stress [26], and insomnia [27,28]. ...
... In a memory test by Bianchi, R, burnout and depression were found to be associated with the decreased recall of positive items and increased recall of negative items. This might explain why drivers with more depressive symptoms were more likely to feel burnout [25]. Furthermore, many studies have shown that the relationship between depression and burnout is bidirectional, i.e., they interact in a vicious cycle or spiral downward, with burnout levels predicting increases in depression over time and depression levels predicting increases in burnout over time [42,43]. ...
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This study aimed to characterize job burnout in longitudinal trajectories among bus drivers and examine the impact of variables related to job burnout for trajectories. A longitudinal study was conducted in 12,793 bus drivers in Guangdong province, China, at 3-year follow-up assessments. Growth mixture modeling (GMM) was used to estimate latent classes of burnout trajectories and multinomial logistic regression models were applied to predict membership in the trajectory classes. In general, there was a decrease in job burnout in 3 years [slope = −0.29, 95%CL = (−0.32, −0.27)]. Among those sub-dimensions, reduced personal accomplishment accounted for the largest proportion. GMM analysis identified five trajectory groups: (1) moderate-decreased (N = 2870, 23%), (2) low-stable (n = 5062, 39%), (3) rapid-decreased (n = 141, 1%), (4) moderate-increased (n = 1504, 12%), and (5) high-stable (n = 3216, 25%). Multinomial logistic regression estimates showed that depression symptoms, anxiety symptoms, and insomnia were significant negative predictors, while daily physical exercise was a significantly positive predictor. We found an overall downward trend in bus drivers’ burnout, particularly in the sub-dimension of personal accomplishment. Mentally healthier drivers and those who were usually exercising were more resilient to occupational stress and less likely to suffer burnout.
... A cognitive bias refers to a systematic error and a simplification in the thinking process that occurs in the brain as people are attempting to interpret the information at hand [2]. More specifically, memory bias refers to the tendency to intentionally or unintentionally rely on recalling certain events and autobiographical memories and favoring those memories over others [3]. This recall process often relates to significant events, including traumatic, unconventional events, or even to systematically selecting the most recent events in a series of events [4]. ...
... In this section, we discuss the design of the app, focusing on the parents' views and how specific app features can help with compliance while reducing memory bias [3][4][5]. The app (see Figure 1) has three primary goals: i) to be readily available for the parents to register symptoms regularly; ii) to visualize data over time to reduce memory bias and; iii) to feed data to the pediatricians treating the children. ...
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Memory bias, the tendency to rely on certain events over others, can become an issue in chronic illnesses, especially when symptoms are reported retrospectively. This paper examines a case where continuous symptom registration can be facilitated, memory supported, and memory bias reduced by introducing a mobile application. The aim of the paper is to report on the design of an app for collecting subjective data over an extended period to continuously follow children with periodic fever. The research approach is qualitative, building on interview data. The design method is co-design, a collaborative and participatory approach involving researchers, physicians and other key stakeholders, with focus on the views of the parents. We argue that collecting data continuously through an app moves the discussion from memory to the specific data points, which is illustrated through trends shown in the visualizations of the data. Moreover, we highlight the importance of systematically collecting data over an extended period through a data-driven approach to both forward clinical practice and research on complex, often chronic topics such as periodic fever, which is genuinely under-researched to date.
... However, Hallsten [29] defined BS as a type of depression resulting from the exhaustion process. Bianchi et al. [30] stated that BS and depression exhibit a very high correlational relationship, and they revealed that the two variables overlap. Similarly, Bianchi and Brisson [31] pointed out that BS and depression overlap at the symptom and etiological level. ...
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Organizational toxicity is a key organizational issue today, impacting the success of both employees and organizations negatively alike. Negative working conditions revealed by organizational toxicity pave the way for an organizational atmosphere to arise, which negatively influences the physical and psychological well-being of employees, causing burnout syndrome and depression. Thus, organizational toxicity is observed to have a destructive impact on employees and can threaten the future of companies. In this framework, this study examines the mediating role of burnout and moderator role of occupational self-efficacy, in the relationship between organizational toxicity and depression. Conducted as cross-sectional, this study adopts a quantitative research approach. To that end, convenience sampling was used to collect data from 727 respondents who are employed at five-star hotels. Data analysis was completed with SPSS 24.0 and AMOS 24 packages. Consequent to the analyses, organizational toxicity was determined to have a positive effect on burnout syndrome and depression. Moreover, burnout syndrome was found to have a mediating effect on the relationship between organizational toxicity and depression. In addition, occupational self-efficacy was found to have a moderator role on the effect of employees' burnout levels on their depression levels. According to the findings, occupational self-efficacy is an influential variable on reducing the impact that organizational toxicity and burnout have on depression.
... Different studies have highlighted that alexithymic deficits are pronounced when emotional facial expressions are masked, ambiguous, or in general difficult to extract (Brewer et al., 2015;Parker et al., 2005;Reker et al., 2010). Moreover, previous experimental evidence indicated that individuals with burnout symptoms had an altered ability to processing emotional cues (Bianchi et al., 2020;Sokka et al., 2014). Colonnello et al. (2021) reported that healthcare professionals with burnout showed a reduction in the accuracy of facial emotion recognition, with a tendency to misclassify negative emotional cues as positive. ...
Objectives: Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. Methods: In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness. Results: Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. Conclusion: Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.
... Depression is a mood disorder accompanied by low self-esteem, impaired cognitive function, and decreased pleasure (Monroe and Anderson, 2015). In human studies of cognitive bias, it was found that depressed subjects are more inclined to focus on negative stimuli (Armstrong and Olatunji, 2012), choose more negative words as self-descriptive (Dainer-Best et al., 2018), and recall more negative items and less positive items on memory tests (Bianchi et al., 2020). Harding et al. were the first to apply the judgment bias paradigm to investigate the cognitive bias of rats (Harding et al., 2004), demonstrating that the JBT can be used to detect negative emotions in animals. ...
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Cognitive biases can arise from cognitive processing under affective states and reflect the impact of emotion on cognition. In animal studies, the existing methods for detecting animal emotional state are still relatively limited, and cognitive bias test has gradually become an important supplement. In recent years, its effectiveness in animal research related to neuropsychiatric disorders has been widely verified. Some studies have found that cognitive bias test is more sensitive than traditional test methods such as forced swimming test and sucrose preference test in detecting emotional state. Therefore, it has great potential to become an important tool to measure the influence of neuropsychiatric disorder-associated emotions on cognitive processing. Moreover, it also can be used in early drug screening to effectively assess the potential effects or side effects of drugs on affective state prior to clinical trials. In this mini-review, we summarize the application of cognitive bias tests in animal models of neuropsychiatric disorders such as depression, anxiety, bipolar disorder, and pain. We also discussed its critical value in the identification of neuropsychiatric disorders and the validation of therapeutic approaches.
... For example, one recent study found that healthcare providers' scores on the depersonalization subscale of the Maslach Burnout Inventory were associated with inaccuracy in characterizing emotional facial expressions, with providers high on depersonalization more likely to misclassify negative emotions as positive (Colonnello et al., 2021). Other research has identified an association between burnout and attention and memory bias for emotionally negative information (Bianchi et al., 2020;Sokka et al., 2014). Here we identify specific linguistic behavior associated with the relationship between burnout and reduced effectiveness among chaplains. ...
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Objectives Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or “active ingredients” of chaplain spiritual consults. Here, we examined how chaplains’ compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes. Methods Hospital chaplains ( n = 16) completed self-report measures that together were operationalized as self-reported “compassion capacity.” Next, chaplains conducted consultations with inpatients ( n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation. Results We found that compassion capacity was significantly associated with chaplains’ LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language. Conclusions These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.
Marital burnout has not been extensively studied despite its huge consequences on family wellbeing and quality of family life. This study, using randomised-controlled trial, tested the impact of rational-emotive couple intervention on marital burnout in a sample of parents seeking a divorce. A total of 67 parents who participated during the rational-emotive couple intervention (RECI) were assessed using the marital burnout scale, Beck depression inventory, and parent rational and irrational beliefs scale. Crosstabulation, multivariate test analysis, and bivariate analysis were used to analyse the data collected. Results show a significant reduction of marital burnout in RECI group participants, and significant improvement was maintained at the follow-up stage. The result of the group and gender interaction effect shows no significant interaction effect of group and gender on participants’ marital burnout at Time two and Time 3, respectively. The results indicate that a decrease in parents’ irrational beliefs accounts for marital burnout among couples seeking a divorce. Marital burnout is positively associated with depression among couples seeking a divorce. This study concludes that the RECI is an effective intervention that reduces marital burnout which is a direct consequence of irrational beliefs which later metamorphose into depressive symptoms.
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Burnout has been defined as a job-induced syndrome combining emotional exhaustion, depersonalization/cynicism, and a sense of reduced personal accomplishment. In this article, we expand on past analyses of burnout by reviewing key, yet overlooked, problems affecting the construct. We concomitantly examine the implications of these problems for the overall validity of burnout research. Our work shows that burnout research is undermined by four main problems. First, what constitutes a case of burnout is unclear. Second, the basic conceptualization and operationalization of burnout are ill-aligned. Third, burnout is unlikely to be the specifically job-induced syndrome it has been posited to be. Fourth, the discriminant validity of the burnout construct is unsatisfactory. These fundamental problems, disregarded for decades, render burnout research inconclusive. This state of affairs (a) bears on researchers’ and practitioners’ ability to monitor and protect workers’ health and (b) prevents public health policy-makers from producing authoritative recommendations. The burnout construct thus appears to not well serve the goal of promoting occupational health. Because burnout overlaps with depression both at a symptom and an etiological level, the depression construct may offer occupational health specialists a way out of the “burnout impasse.” Depression is diagnosable. Like burnout, depression can be studied dimensionally (i.e., as a process) and examined from both an individual and a social standpoint. Methods for investigating the etiological link between depressive symptoms and disorders and job stress are available. We recommend that occupational health specialists (a) shift their focus from burnout to job-related depression and (b) reinforce initiatives aimed at combatting depression-related stigma.
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Burnout has been commonly regarded as a job-induced syndrome. In this 468-participant study (67% female; mean age: 46.48), we examined the extent to which individuals with burnout and depressive symptoms attribute these symptoms to their job. Fewer than half (44%) of the individuals with burnout symptoms viewed their job as the main cause of these symptoms. The proportion of participants ascribing their depressive symptoms to work was similar (39%). Results from correlation and cluster analyses were indicative of burnout-depression overlap. Our findings suggest that burnout might not be a specifically job-induced syndrome and further question the burnout construct’s validity.
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Depression researchers have long considered depressive disorders to be associated with specific cognitive processes. In the current chapter, we examine the relationship between depressive disorders (especially major depressive disorder [MDD]) and perceptual-cognitive processing of emotional contents. We describe some characteristics of depressive patients’ Umwelts (i.e., unique perceptual-cognitive worlds) and causal mechanisms contributing to depressive symptom severity. Emotion processing in depression has usually been regarded as biased (regarding interpretation, memory, “attention”) toward specific “negative” emotional stimulations. This robust finding generally concerns adults as well as adolescents and children. Some “attentional biases,” however, cannot be easily described based on the classical “omnibus” mood-congruent information processing hypothesis, especially in children and elderly patients with MDD. In our view, both theoretical and practical breakthroughs could occur in the near future in the field of depression and perceptual-cognitive processing. First, a lifespan developmental approach to cognition–depression interactions could exert major influence on research designs, because most of the cognitive biases identified in adult depression are already present in child and adolescent depression. Second, combined cognitive bias (CCB) models, integrating various implications of depressive disorders for perception and cognition, will help us understand and inform the mutual influences between interpretation, memory, and “attentional” biases. Third, behavioral epigenetics, the primary outputs of which have begun to inform us about the role of gene x environment interactions in “attention” distribution, represents a promising epistemological framework for a complexity-oriented approach to depression. Such a framework is highly needed given the number of factors interacting in the development of depression.
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Previous research has found that cognitive biases in attention, interpretation, and memory play an important role in depression. However, there is little knowledge of the interplay between these biases in clinical depression. The present study was aimed to model different pathways of relation among attention, interpretation and autobiographical memory biases, and to examine their contribution to account for depression status outcomes. Cognitive biases were evaluated in a sample comprising 22 currently-depressed and 36 never-depressed individuals representing a broad range of depression severity levels. Cognitive biases were assessed by three separate tasks using different types of stimuli. Our main finding was a significant indirect effect model in which attention bias to negative faces was linked to greater negative memory bias via its association with negative interpretation bias. Within this model, the specific pathway between attention bias to negative faces and negative interpretation bias accounted both for significant variance in depression severity as well as for depression diagnostic status. These findings increase our understanding of the complex interplay between cognitive mechanisms involved in clinical depression and highlight hypothetical pathways relevant for future interventions.
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The aim of this chapter is to provide an overview of the burnout syndrome, a condition initially described in psychology in the mid-1970s. We start by depicting the pioneering phase of burnout research that led to the introduction of the burnout construct in the scientific literature. We then describe the shift from initial exploratory and mainly qualitative research on burnout to more systematic, quantitative research on the syndrome. Finally, we summarize the most recent findings pertaining to the characterization of the burnout syndrome. These findings compellingly suggest that the syndrome referred to as burnout is depressive in nature. Overall, the case of the burnout syndrome highlights the need for more conceptual parsimony and theoretical integration in psychology and psychiatry and calls for enhanced transdisciplinary communication in the fields of stress and depression research.
Individuals seeking treatment for depression are often struggling with maladaptive cognitions that impact how they view themselves and the world. Research on cognitive attributions that underlie depressed mood focuses on the phenomenon of negative cognitive style, in which depressed people tend to view undesirable occurrences in life as having internal, stable, and global causes. On the basis of research, clinicians have developed various techniques that seek to modify depressive attributions in order to alleviate symptoms of depression. In this article, the authors review the literature on attributions in depression, present clinically relevant interventions based on empirical support, provide case examples, and summarize future directions and recommendations for researchers and practitioners.
Background: The PHQ-9 was originally developed as a screener for depression in primary care and is commonly used in medical settings. However, surprisingly little is known about its psychometric properties and utility as a severity measure in psychiatric populations. We examined the full range of psychometric properties of the PHQ-9 in patients with a range of psychiatric disorders (i.e., mood, anxiety, personality, psychotic). Methods: Patients (n=1023) completed the PHQ-9 upon admission and discharge from a partial hospital, as well as other self-report measures of depression, anxiety, well-being, and a structured diagnostic interview. Results: Internal consistency was good (α=.87). The PHQ-9 demonstrated a strong correlation with a well-established measure of depression, moderate correlations with related constructs, a weak correlation with a theoretically unrelated construct (i.e., disgust sensitivity), and good sensitivity to change, with a large pre- to post-treatment effect size. Using a cut-off of ≥13, the PHQ-9 demonstrated good sensitivity (.83) and specificity (.72). A split-half exploratory factor analysis/confirmatory factor analysis suggested a two-factor solution with one factor capturing cognitive and affective symptoms and a second factor reflecting somatic symptoms. Psychometric properties did not differ between male and female participants. Limitations: No clinician-rated measure of improvement, and the sample lacked ethnoracial diversity. Conclusions: This first comprehensive validation of the PHQ-9 in a large, psychiatric sample supported its use as a severity measure and as a measure of treatment outcome. It also performed well as a screener for a current depressive episode using a higher cut-off than previously recommended for primary care samples.
We examined whether burnout is associated with a depressive cognitive style, understood as a combination of dysfunctional attitudes, ruminative responses, and pessimistic attributions. A total of 1,386 U.S. public school teachers were included—1,063 women (MAGE: 42.73, SDAGE = 11.36) and 323 men (MAGE: 44.60, SDAGE = 11.42). Burnout was assessed with the Shirom-Melamed Burnout Measure (SMBM). Dysfunctional attitudes were measured with the Dysfunctional Attitude Scale Short Form, ruminative responses with the Ruminative Responses Scale, and pessimistic attributions with the Depressive Attributions Questionnaire. For comparative purposes, depression was assessed using the 9-item depression module of the Patient Health Questionnaire (PHQ-9). Dysfunctional attitudes, ruminative responses, and pessimistic attributions were each similarly associated with burnout and depression. Moreover, the correlations between the SMBM and the PHQ-9 that we observed were comparable to the correlations between the SMBM and the Maslach Burnout Inventory-General Survey reported in past research. Dysfunctional attitudes, ruminative responses, and pessimistic attributions were more characteristic of individuals with high frequencies of burnout (or depressive) symptoms than of their counterparts with low frequencies of burnout (or depressive) symptoms. This study suggests that burned out individuals live in a depressive cognitive world, consistent with the view that burnout is a depressive syndrome.