Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons

Burnout and behavior-related health risk factors: results from the population-based Finnish Health 2000 study

OBJECTIVE

To explore the relationship between burnout and behavior-related health risk factors.

METHODS

We collected data from a population-based sample (n = 3264) through interviews, questionnaires, and health examinations. Burnout was assessed using the Maslach Burnout Inventory-General Survey. Smoking, alcohol consumption, and leisure-time physical activity were self-reported. Obesity was based on measurements at screening.

RESULTS

Burnout and exhaustion were associated with a higher likelihood of risk factors. More specifically, burnout syndrome was related to low physical activity and obesity, exhaustion dimension to low physical activity and heavy drinking, cynicism dimension to low physical activity, and diminished professional efficacy to low physical activity, obesity, and lower likelihood of heavy drinking.

CONCLUSIONS

Improving working conditions and psychoeducation on recommended ways of coping and recovery could help to prevent negative health consequences of chronic work stress.

Occupational burnout, eating behavior, and weight among working women

BACKGROUND

Eating behavior affects weight and thus the development of obesity. Studies on the effect of occupational burnout (exhaustive fatigue, cynicism, and lost occupational self-respect caused by chronic work stress) on eating behavior are lacking.

OBJECTIVE

The objective was to investigate associations between occupational burnout, eating behavior, and weight among working women.

DESIGN

A total of 230 working women participated in a randomized controlled intervention trial (Nuadu) that aimed at changing the health behaviors of those with health risks. We assessed eating behavior using the Three-Factor Eating Behavior Questionnaire 18 and burnout using the Bergen Burnout Indicator 15 at both baseline and 12 mo. Body weight and percentage body fat were also measured at baseline and at 12 mo. The intervention and control groups were combined and divided by burnout and weight-change variables.

RESULTS

Women experiencing burnout at baseline had significantly higher scores in emotional eating (EE; P = 0.002) and uncontrolled eating (UE; P = 0.001) than did those without burnout. A significant difference was found between the change in UE from baseline to 12 mo in those with and without burnout (P = 0.05). UE decreased significantly among those without burnout at baseline (P < 0.001).

CONCLUSIONS

Those experiencing burnout may be more vulnerable to EE and UE and have a hindered ability to make changes in their eating behavior. We recommend that burnout should be treated first and that burnout and eating behavior should be evaluated in obesity treatment.

Burnout among foreign-born and native Swedish women: a longitudinal study

The authors of this study addressed burnout experiences (generally defined as chronic depletion of an individual's energetic resources') over time in relation to other factors (e.g., distress, sleep difficulties, job demands, etc.) among foreign-born women and Swedish native women living in Stockholm. The study design was a longitudinal panel survey with two waves one year apart. In the first wave, 3,616 of 6,000 randomly selected women took part, and 2,300 of the initial 3,616 women also participated in the second wave; 427 were foreign-born women, and 1,873 were Swedish native women. Baseline/emerging distress, emerging sleep difficulties, worsening general social support, job demands at baseline/escalating during the assessment period, emerging unemployment, constraints in social support at work, and sustained/emerging financial strain were associated with future burnout, regardless of background. More foreign-born women than Swedish native women reported burnout, with these differences maintained at one-year follow-up. The factors related to burnout were largely the same in both groups, but smoking and cardiovascular disease were related to burnout only among foreign-born women. Younger age, job demands, and working hours were associated with burnout among Swedish native women. The authors found that the women had concurrent problems such as burnout, distress, and sleep problems, but foreign background was not independently related to burnout.

Psychosocial job stress and immunity: a systematic review

The purpose of this review was to provide current knowledge about the possible association between psychosocial job stress and immune parameters in blood, saliva, and urine. Using bibliographic databases (PubMed, PsychINFO, Web of Science, Medline) and the snowball method, 56 studies were found. In general, exposure to psychosocial job stress (high job demands, low job control, high job strain, job dissatisfaction, high effort-reward imbalance, overcommitment, burnout, unemployment, organizational downsizing, economic recession) had a measurable impact on immune parameters (reduced NK cell activity, NK and T cell subsets, CD4+/CD8+ ratio, and increased inflammatory markers). The evidence supports that psychosocial job stresses are related to disrupted immune responses but further research is needed to demonstrate cause-effect relationships.

The role of psychosocial factors in the course of pain--a 1-year follow-up study among women living in Sweden

The understanding of the associations between psychosocial factors and persistent pain and their impact on the course of pain among women is crucial to identify risk populations and prevent long-term pain from developing. The aim of the study was to investigate the course of pain among women and the psychosocial factors associated with it. The study was a 1-year follow-up (FU) among 2,300 women in the general population of Sweden. Sociodemographic and psychosocial factors were analyzed in relation to the course of pain, assessed as the presence of pain during the last 3 months at baseline (BL) and at FU. Thirty-three percent of the women with no pain at BL and 77% of those with pain at BL reported pain at FU. Compared to the pain-free women, those who developed pain at FU reported lower social support and physical quality of life (QoL) and worse mental health. Women with sustained pain were older and reported worse mental health, lack of social support, and lower levels of QoL compared to those who recovered from pain. In the multiple logistic regression analyses, only post-traumatic stress symptoms were associated with the development of pain at FU. Number of pain locations and pain duration at BL and physical QoL were associated with sustained pain. Moreover, social support was identified as a protective factor against sustained pain. Pain is persistent or recurrent in a general female population. The results indicate that psychosocial factors do not work as primary predictors in the course of pain and might be better understood through indirect processes by limiting the individual's resources for handling pain in a functional manner.

Burnout: a fashionable diagnosis

BACKGROUND

"Burnout syndrome" is now a common reason for medical excuses from work, and thus an important topic in health-related economics. Much research is still needed, however, to establish the scientific basis for this entity, the criteria by which it might be diagnosed and classified, and how it should be treated.

METHODS

A systematic review of this topic, previously published as an HTA report, is presented here together with a selective overview of pertinent literature.

RESULTS

There currently exists neither an officially accepted definition nor a valid instrument for the differential diagnosis of burnout syndrome. Its manifestations are generally considered to lie along three dimensions: emotional exhaustion, depersonalization, and reduced performance ability and/or motivation. Most of the available studies on its epidemiology and differential diagnosis provide no more than a low level of evidence for their conclusions. There have been no controlled trials of treatments for burnout.

CONCLUSION

High-quality controlled studies on burnout syndrome are lacking. A standardized and internationally accepted diagnostic instrument with a validated rating scale should be developed. There is also a need for epidemiological and health-economic studies on the prevalence, incidence, and cost of burnout. The etiology and pathogenesis of burnout should be studied with special regard to the possible role of neurobiological factors. Treatments for it should be studied systematically so that their effects can be judged at a high level of evidence. In view of the current lack of knowledge about what is called "burnout," the term should not be used as a medical diagnosis or as a basis for decisions regarding disability or other socioeconomic matters.

Low total testosterone is associated with increased risk of incident type 2 diabetes mellitus in men: results from the Study of Health in Pomerania (SHIP)

OBJECTIVE

There is increasing evidence suggesting that low total testosterone concentration is associated with incident type 2 diabetes mellitus (T2DM) in men. The aim of this study was to evaluate the association between total testosterone and incident T2DM in a large population-based cohort.

METHODS

Of 2117 men at baseline, 1589 were followed up 5 years later. Low total testosterone concentration at baseline determined by <10th percentile (10-year age-strata) were used as a risk factor for incident T2DM at follow-up. To evaluate for potential non-response bias, drop out weights were used in sensitivity analysis.

RESULTS

From 1339 men eligible for analyses, 68 (5.1%) developed T2DM. Men with low total testosterone concentration had an increased risk of developing T2DM (odds ratio [OR] 3.4, 95% CI 1.9-6.1), even after adjustment for age, waist circumference and smoking, OR 3.0; (95% CI 1.6-5.7). Recalculated weighted models revealed almost identical estimates indicating no relevant non-response bias.

DISCUSSION

Our prospective findings suggest that low total testosterone concentration is associated with incident T2DM in men and might represent a biomarker that might causally be involved in the risk of T2DM. This underlines the importance of measuring total testosterone in men as the predominant male sex hormone.

Life and Job Satisfaction as Predictors of the Incidence of Diabetes

We studied the hypothesised effects of baseline levels of life satisfaction and of job satisfaction on the incidence of diabetes. Participants were 2,305 apparently healthy men and women who underwent routine health checks at two points in time, about 20 months apart. New cases of diabetes (N=104) were defined based on fasting glucose value > 125, or glycosylated hemoglobin value > 6.5, or self-reported physician diagnosis of diabetes and taking medications to treat it. Life satisfaction was measured using the scale constructed by Diener et al. (1985) while job satisfaction was assessed based on the Survey of Working Conditions. In the analyses, we controlled for socio-demographic predictors, for known physiological and behavioral precursors of diabetes, and for depressive symptoms. There was support for our hypothesis that the higher the baseline levels of life satisfaction, the lower the incidence of diabetes. However, job satisfaction did not predict the incidence of diabetes. We obtained the same results when limiting the analysis to new cases of diabetes based on objective criteria only and when using as predictors both life and job satisfaction. We suggest that life satisfaction could be a protective factor reducing the risk of diabetes.

Biomarkers in burnout: a systematic review

BACKGROUND

Burnout is a stress state characterized by symptoms of mental exhaustion and physical fatigue, detachment from work, and feelings of diminished competence. Several biomarkers have been tested for association with burnout, but the results are conflicting.

AIM

The objective of this review was to identify potential biomarkers for burnout.

METHODS

We carried out a systematic review of studies comparing biomarkers in individuals with burnout and healthy controls, or individuals with low scores and those with high scores on burnout questionnaires. Literature searches in MEDLINE and EMBASE were performed. We describe biomarkers on which at least three studies were available. Where appropriate, a meta-analysis was carried out.

RESULTS

We identified 31 studies on 38 biomarkers involved in the hypothalamus-pituitary-adrenal axis, autonomic nervous system, immune system, metabolic processes, antioxidant defense, hormones, and sleep. At least 3 studies were available for cortisol in saliva and blood, blood pressure, heart rate, cholesterol, dehydroepiandrosterone sulfate, (numbers or activity of) natural killer cells, C-reactive protein, and prolactin. The comparability of studies was limited, due to differences in the methods used to characterize patients and controls, to assess biomarkers, and to control for confounders. Furthermore, burnout was operationalized in different ways. Meta-analyses showed no differences for cortisol awakening response and cortisol awakening response after administration of dexamethasone, cortisol in blood, and blood pressure.

CONCLUSIONS

No potential biomarkers for burnout were found, largely due to the incomparability of studies. We emphasize the need for a dimensional and longitudinal approach in future research to account for the heterogeneity of burnout.

Conceito(s) de burnout: questões atuais da pesquisa e a contribuição da clínica

Considerando o crescente interesse científico no fenômeno burnout, apresentamos uma amostra da diversidade teórica que forma o campo de pesquisa neste tema a partir de algumas questões atuais de discussão sobre o seu conceito. Discutimos aparentes limitações da abordagem empírica à compreensão da natureza conceitual do burnout, apontando uma possível contribuição da clínica (dentro do campo da Psiquiatria) a este debate.

Feeling vigorous and the risks of all-cause mortality, ischemic heart disease, and diabetes: a 20-year follow-up of healthy employees

OBJECTIVE

To investigate prospectively the effects of vigor at work on the end points of mortality and the prevalence of ischemic heart disease (IHD) and diabetes.

METHODS

We tested the hypothesized beneficial effects of feeling vigorous at work at baseline on the risks of all-cause mortality, IHD, and diabetes during a 20-year follow-up. Participants were healthy employees (n = 968) who underwent a routine health check at baseline. We calculated the risk of all-cause mortality, IHD, and diabetes, with days as the time scale, using the Cox proportional hazard model. In our analyses, we predicted the above end points by baseline vigor, age, gender, and educational level, adjusting for the physiological risk factors of total cholesterol, glucose, and body mass index, the behavioral risk factors of smoking, alcohol intake, and physical activity, and the psychological risk factors of depressive and anxiety symptoms.

RESULTS

As hypothesized, we found that, after the above adjustments, baseline vigor decreased the risk of follow-up mortality by 26% (hazard ratio, 0.74; 95% confidence interval, 0.58-0.95) and the risk of diabetes by 17% (hazard ratio, 0.83; 95% confidence interval, 0.68-0.98). However, vigor did not have a significant effect on the risk of IHD.

CONCLUSIONS

Independently of physiological, behavioral, and psychological risk factors, feeling vigorous at work protected the participants from diabetes and reduced their risk of mortality.

The role of corticosteroids and stress in chronic pain conditions

The relationship between corticosteroids (endogenous and exogenous) and stress is well known, as is the use of steroids as concomitant treatment in pain management during acute inflammation. In the past, steroids have not been considered the first line of treatment in pain management. In this review, we examine new scientific and clinical evidence that demonstrates the direct role that steroids play in the generation and clinical management of chronic pain. We will discuss the new findings demonstrating the fact that steroids and related mediators produce paradoxical effects on pain such as analgesia, hyperalgesia, and even placebo analgesia. In addition, we will examine the physiologic effect of stress, high allostatic load, and idiopathic disease states such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and burnout. The recently observed positive relationship between glutaminergic activity in the insula and clinical pain will be examined in the context of understanding the central role of steroids in chronic pain. The complex role of the hypothalamic-pituitary-adrenal axis in pain will be discussed as well as other heterogeneous forms of chronic pain that involve many components of the central nervous system. Components of the hypothalamic-pituitary-adrenal axis have paradoxical effects on certain types of pain that are dependent on dose and on site (whether peripheral or central) and mode of application. Recent studies on glia have shown that they prolong a state of neuronal hypersensitization in the dorsal root ganglia by releasing growth factors and other substances that act on the immune system. We will discuss the implication of these new findings directly linking pain to steroids, stress, and key higher brain regions in the context of future therapeutic targets.

Workplace bullying in health care affects the meaning of work

Our purpose in this grounded theory study was to explore the impact of workplace bullying (WPB) on women working in health care. We analyzed interviews with 21 women, professionals and nonprofessionals. The women experienced a change in their meaning of work (MOW) when they had experienced WPB, and they addressed this change through a process we called the shifting meaning of work. This process has three stages. The first, developing insight, involves recognizing causes of changed MOW as external. In the second stage, resisting, women defend against changed MOW by sustaining acceptable MOW and work performances, and by confronting causes. In the final stage, rebuilding, women try to adapt and modify approaches to work by coming to terms, adjusting work attitudes, and investing in self. We identified implications of this process for managing health and work issues with women, health care providers, and employers.

Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study

OBJECTIVE

Burnout, a psychological consequence of prolonged work stress, has been shown to coexist with physical and mental disorders. The aim of this study was to investigate whether burnout is related to all-cause mortality among employees.

METHODS

In 1996, of 15,466 Finnish forest industry employees, 9705 participated in the 'Still Working' study and 8371 were subsequently identified from the National Population Register. Those who had been treated in a hospital for the most common causes of death prior to the assessment of burnout were excluded on the basis of the Hospital Discharge Register, resulting in a final study population of 7396 people. Burnout was measured using the Maslach Burnout Inventory-General Survey. Dates of death from 1996 to 2006 were extracted from the National Mortality Register. Mortality was predicted with Cox hazard regression models, controlling for baseline sociodemographic factors and register-based health status according to entitled medical reimbursement and prescribed medication for mental health problems, cardiac risk factors, and pain problems.

RESULTS

During the 10-year 10-month follow-up, a total of 199 employees had died. The risk of mortality per one-unit increase in burnout was 35% higher (95% CI 1.07-1.71) for total score and 26% higher (0.99-1.60) for exhaustion, 29% higher for cynicism (1.03-1.62), and 22% higher for diminished professional efficacy (0.96-1.55) in participants who had been under 45 at baseline. After adjustments, only the associations regarding burnout and exhaustion were statistically significant. Burnout was not related to mortality among the older employees.

CONCLUSION

Burnout, especially work-related exhaustion, may be a risk for overall survival.

Some risk factors for the development of type 2 Diabetes in men and women of Belgrade population

Introduction. In the last two decades there has been an increase in the prevalence of type 2 diabetes in both developed and in developing countries. Objective. To determine whether personal habits like smoking, alcohol and coffee consumption or physical inactivity are different between genders in patients with type 2 diabetes. Methods. The study was conducted in Belgrade, during the period 2007-2008, and included newly diagnosed patients with type 2 diabetes. We included 80 men and 99 women diagnosed with diabetes mellitus type 2, referred to the Primary Health Care Centre 'Savski venac'. A questionnaire was used to collect data on demographic and anthropometric characteristics, as well as data on healthy habits. The ?I test and two-tailed t-test were used for data analysis. Results. The men were significantly more engaged in industry and crafts, while the women worked significantly more frequently in administrative jobs. The men were married significantly more frequently than the women (p<0.05) and had a higher level of education (p<0.05). Regarding to the level of implementation of nutritional and physical activity, there were no significant differences between the genders (p>0.05). The women consumed coffee significantly more frequently than the men (p<0.05), but drank less alcohol (p<0.05). The men were former smokers significantly more frequently (p<0.05) than the women. Conclusion. These results indicate the role of certain personal habits in the development of type 2 diabetes.

Organizational traits, care processes, and burnout among chronic hemodialysis nurses

In light of evidence linking registered nurse (RN) staffing levels to patient outcomes in chronic hemodialysis facilities, U.S. government regulations have set minimum RN staffing requirements during dialysis. Consequently, facility administrators are focused on decreasing nurse attrition in this crucial practice setting. This study used a cross-sectional, correlational design to investigate the effects of workload, practice environment, and care processes on burnout among nurses in U.S. chronic hemodialysis centers and to determine the association between burnout and nurses' intentions to leave their jobs. Findings indicate that predictors were associated with an increased likelihood of nurse burnout and that nurses experiencing burnout were more likely to be planning to leave their jobs. Findings have important implications for retention of nurses, enhancement of patient safety, and adherence to new federal staffing requirements in chronic hemodialysis units.

Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers

Epidemiological studies have shown that chronic work stress or unfavourable psychosocial work conditions are prospectively associated with different adverse health outcomes. The aim of the present cross-sectional study was to investigate the relationship between work-related chronic stress as well as exhaustion and a cumulative measure of physiological wear-and-tear called allostastic load (AL). AL could be a possible biological pathway for how chronic work stress and exhaustion lead to health impairments in the long run. As the teaching profession has been proposed to be a potentially high stressful occupation, chronic work stress (effort-reward-imbalance) and exhaustion were assessed in 104 female school teachers. AL was first analyzed according to McEwen's classical model comprised of ten parameters including cortisol, epinephrine and norepinephrine, dehydroepiandrosterone-sulphate (DHEA-S), waist/hip-ratio (WHR), glycosylated haemoglobin (HbA1c), high-density lipoprotein (HDL), total cholesterol/HDL-ratio, and systolic and diastolic blood pressure. Additionally it was extended to include tumor-necrosis-factor-alpha (TNF-alpha), C-reactive protein (CRP), fibrinogen, D-dimer, percent-body-fat, triglycerides, and glucose levels. A substantial proportion of our sample was highly exhausted whereas relatively few teachers showed high effort-reward-imbalance. AL scores were significantly higher in women high on effort-reward-imbalance or suffering from exhaustion. Although all teachers had been in a good health status, chronic work stress as well as exhaustion appears to be associated with changes in a multi-system summary indicator of physiological risk.

On the nature of burnout-insomnia relationships: a prospective study of employed adults

OBJECTIVE

This prospective study was designed to test the hypothesis that burnout and insomnia predict each other's incidence and intensification across time. Burnout is conceptualized as representing individuals' unique affective response to their exposure to chronic stressors.

METHOD

Apparently healthy respondents (1356) completed questionnaires during periodic health examinations undergone at two time points T(1) and T(2), about 18 months apart. Burnout was assessed by the Shirom-Melamed Burnout Measure, while insomnia was assessed by the Brief Athens Insomnia Scale. Depressive symptomatology, neuroticism, body mass index, age, gender, follow-up duration, and T(1) levels of the criterion were controlled.

RESULTS

Burnout and insomnia were found to be only moderately associated at T(1). However, logistic regression results indicated that burnout significantly predicted the development of new cases of insomnia at 18-month follow-up [odds ratio (OR)=1.93; 95% confidence interval (95% CI)=1.45-2.58], even after adjusting for depression and other potent confounders. Likewise, insomnia significantly predicted the onset of new cases of burnout at 18-month follow-up (OR=1.64; 95% CI=1.30-2.08). Hierarchical regression results indicted that T(1) burnout significantly predicted an increase in T(2) insomnia (beta=.05, P<.05), and that T(1) insomnia significantly predicted an increase in T(2) burnout (beta=.07, P<.05).

DISCUSSION

The results indicate that burnout and insomnia recursively predict each other's development and intensification over time, thus suggesting that either might be a risk factor for the other across time. Possible mechanisms of link between burnout and insomnia, as well as the clinical implications of the findings, were suggested.

Physiology and neurobiology of stress and adaptation: central role of the brain

The brain is the key organ of the response to stress because it determines what is threatening and, therefore, potentially stressful, as well as the physiological and behavioral responses which can be either adaptive or damaging. Stress involves two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Beyond the "flight-or-fight" response to acute stress, there are events in daily life that produce a type of chronic stress and lead over time to wear and tear on the body ("allostatic load"). Yet, hormones associated with stress protect the body in the short-run and promote adaptation ("allostasis"). The brain is a target of stress, and the hippocampus was the first brain region, besides the hypothalamus, to be recognized as a target of glucocorticoids. Stress and stress hormones produce both adaptive and maladaptive effects on this brain region throughout the life course. Early life events influence life-long patterns of emotionality and stress responsiveness and alter the rate of brain and body aging. The hippocampus, amygdala, and prefrontal cortex undergo stress-induced structural remodeling, which alters behavioral and physiological responses. As an adjunct to pharmaceutical therapy, social and behavioral interventions such as regular physical activity and social support reduce the chronic stress burden and benefit brain and body health and resilience.