Post-awakening salivary alpha-amylase as modulator of treatment response in patients with burnout and major depression

Around 50% of patients with major depression do not respond to standard first-line treatments, such as psychotherapy and pharmacotherapy. At the same time, a subgroup exhibits altered functioning of stress-responsive bodily systems, such as the central locus coeruleus/sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Given that these systems impact arousal and cognition, it is possible that this subgroup contributes to the high rates of non-responders. Our aim was to investigate whether sympathetic and HPA axis activity modulate treatment outcomes in patients with stress-related major depression. A total of N = 74 inpatients (median age: 50, 62% male) with signs of burnout who fulfilled diagnostic criteria for major depression were recruited. Saliva samples were collected at awakening as well as 30 and 45 min later. Alpha-amylase activity and cortisol concentrations were determined before patients underwent evidence-based multimodal treatment. Non-responders were defined as patients exhibiting a <50% decrease in depression on the Beck Depression Inventory. Non-responders had significantly higher post-awakening alpha-amylase activity than responders (p = .025). In addition, alpha-amylase activity increased significantly over the course of treatment (p = .004), irrespective of responder status. Post-awakening cortisol was neither a predictor nor an indicator of treatment response. If future research confirms alpha-amylase activity as a modulator of treatment response, this may indicate a subgroup of patients with major depression which may benefit from augmentative treatments, such as heart rate variability biofeedback and/or cognitive interventions targeting high arousal.

Burnout subtypes: Psychological characteristics, standardized diagnoses and symptoms course to identify aftercare needs

Background

To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants.

Method

Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up.

Results

As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients.

Conclusion

The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients.

Four burnout subtypes were found: Functional, Dysfunctional, Straightforward Pragmatist, and Unhappy Altruist.

Psychosocial characteristics and symptom levels at admission, discharge, and follow-up were described to better characterize the subtypes.

The replicated and enriched characterization of burnout inpatients improves individually tailored treatments.

Coping with stress and types of burnout: explanatory power of different coping strategies

Background

Burnout occurs when professionals use ineffective coping strategies to try to protect themselves from work-related stress. The dimensions of ‘overload’, ‘lack of development’ and ‘neglect’, belonging to the ‘frenetic’, ‘under-challenged’ and ‘worn-out’ subtypes, respectively, comprise a brief typological definition of burnout. The aim of the present study was to estimate the explanatory power of the different coping strategies on the development of burnout subtypes.

Methods

This was a cross-sectional survey with a random sample of university employees, stratified by occupation (n = 429). Multivariate linear regression models were constructed between the ‘Burnout Clinical Subtypes Questionnaire’, with its three dimensions –overload, lack of development and neglect– as dependent variables, and the ‘Coping Orientation for Problem Experiences’, with its fifteen dimensions, as independent variables. Adjusted multiple determination coefficients and beta coefficients were calculated to evaluate and compare the explanatory capacity of the different coping strategies.

Results

The ‘Coping Orientation for Problem Experiences’ subscales together explained 15% of the ‘overload’ (p<0.001), 9% of the ‘lack of development’ (p<0.001), and 21% of the ‘neglect’ (p<0.001). ‘Overload’ was mainly explained by ‘venting of emotions’ (Beta = 0.34; p<0.001); ‘lack of development’ by ‘cognitive avoidance’ (Beta = 0.21; p<0.001); and ‘neglect’ by ‘behavioural disengagement’ (Beta = 0.40; p<0.001). Other interesting associations were observed.

Conclusions

These findings further our understanding of the way in which the effectiveness of interventions for burnout may be improved, by influencing new treatments and preventive programmes using features of the strategies for handling stress in the workplace.