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Li Y, Wang L, He Y, Zhu S, He SC, Zhang XY. Genetic polymorphisms in the 5-HT and endocannabinoid systems moderate the association between childhood trauma and burnout in the general occupational population. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111054. [PMID: 38879068 DOI: 10.1016/j.pnpbp.2024.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Interactions between the serotonin (5-HT) and endocannabinoid (eCB) systems have been reported in the psychopathology of stress-related symptoms, while their interplay in regulating the relationship between childhood trauma and burnout remains unclear. In this study, we investigated the interaction of childhood trauma with genetic polymorphisms in these two systems in predicting burnout. METHODS Burnout, childhood trauma, and job stress were assessed using rating scales in 992 general occupational individuals. Genetic polymorphisms including HTR2A rs6313, 5-HTT rs6354 and FAAH rs324420, were genotyped. Linear hierarchical regression analysis and PROCESS macro in SPSS were used to examine two- and three-way interactions. RESULTS There were significant interactions of job stress × HTR2A rs6313 and childhood abuse × FAAH rs324420 on reduced personal accomplishment. Moreover, we found significant three-way interactions of childhood abuse × FAAH rs324420 × HTR2A rs6313 on cynicism and reduced personal accomplishment, childhood abuse × FAAH rs324420 × 5-HTT rs6354 on emotional exhaustion, and childhood neglect × FAAH rs324420 × 5-HTT rs6354 on reduced personal accomplishment. These results suggest that the FAAH rs324420 A allele carriers, when with some specific genetic polymorphisms of 5-HT system, would show more positive associations between childhood trauma and burnout. CONCLUSIONS Genetic polymorphisms in the 5-HT and eCB systems may jointly moderate the impact of childhood trauma on burnout.
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Affiliation(s)
- Yuling Li
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, China; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China; School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, China
| | - Lei Wang
- Department of Medical Psychology, Strategic Support Force Medical Center, Beijing, China
| | - Yingyi He
- Department of Psychology, College of Arts and Sciences, The Ohio State University, Columbus 43210, OH, United States
| | - Shuanggen Zhu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China.
| | - Shu-Chang He
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Healthy, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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2
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Kramuschke M, Renner A, Kersting A. [Burnout : Symptoms, diagnostics and treatment approaches]. DER NERVENARZT 2024; 95:484-493. [PMID: 38625570 DOI: 10.1007/s00115-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
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Affiliation(s)
- M Kramuschke
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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van de Leur JC, Jovicic F, Åhslund A, McCracken LM, Buhrman M. Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. Int J Behav Med 2024; 31:175-191. [PMID: 37308772 PMCID: PMC11001660 DOI: 10.1007/s12529-023-10185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions. METHODS A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL. RESULTS Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation. CONCLUSIONS While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.
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Affiliation(s)
- Jakob Clason van de Leur
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
- PBM Globen Rehab, Arenavägen 27, 121 77, Johanneshov, Sweden.
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Andreas Åhslund
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Lance M McCracken
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
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John A, Bouillon-Minois JB, Bagheri R, Pélissier C, Charbotel B, Llorca PM, Zak M, Ugbolue UC, Baker JS, Dutheil F. The influence of burnout on cardiovascular disease: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1326745. [PMID: 38439796 PMCID: PMC10909938 DOI: 10.3389/fpsyt.2024.1326745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background Burnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease. Methods Studies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks. Results We included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case-control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions. Conclusions Burnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.
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Affiliation(s)
- Awena John
- Université Clermont Auvergne, CHU Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Carole Pélissier
- Université Jean Monnet Saint-Etienne, IFSTTAR, Université Lyon 1, UMRESTTE, CHU Saint-Etienne, Occupational Medicine, Saint-Etienne, France
| | - Barbara Charbotel
- Université Lyon 1, UMRESTTE, CHU Lyon, Occupational Medicine, Lyon, France
| | - Pierre-Michel Llorca
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, CHU Clermont-Ferrand, Psychiatry, Clermont-Ferrand, France
| | - Marek Zak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Kielce, Poland
| | - Ukadike C. Ugbolue
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, United Kingdom
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Frederic Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Cler-mont-Ferrand, Occupational Medicine, WittyFit, Clermont-Ferrand, France
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Claeson AS, Edvardsson B, Liljelind I. Stress and Sleep in Relation to Severity of Building Related Symptoms. J Occup Environ Med 2023; 65:541-545. [PMID: 36952319 DOI: 10.1097/jom.0000000000002844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE This study investigates different aspects of stress and sleep in medically examined individuals with varying severity of building-related symptoms (BRS). METHODS Three questionnaires were used to assess acute and long-term stress and sleep (Perceived Stress Scale; Shirom Melamed Burnout Questionnaire, and Karolinska Sleep Questionnaire). RESULTS Individuals with BRS, regardless of severity, did not differ in level of perceived stress (indicator of short-term stress). The indicators of long-term stress differed between the groups where an increased severity was associated with higher levels of burnout and sleep problems. CONCLUSIONS The study suggests an association between symptom severity and measures of long-term stress and sleep quality. This has implications for the treatment of persons affected by BRS, because not only the environment needs to be treated, but also the concurrent signs of distress, such as burnout or sleep problems.
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Affiliation(s)
- Anna-Sara Claeson
- From the Department of Psychology, Umeå University, Umeå, Sweden (A.C); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.E., I.L.)
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Higher allostatic load in work-related burnout: The Regensburg Burnout Project. Psychoneuroendocrinology 2022; 143:105853. [PMID: 35792379 DOI: 10.1016/j.psyneuen.2022.105853] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Burnout and chronic work stress have been linked to various negative health outcomes. While the mechanisms underlying this interplay are still unclear, the allostatic load (AL) model was suggested to demonstrate a possible biological pathway. However, previous studies provided divergent results regarding the association between burnout and AL, probably also due to the heterogeneity of selected samples. Therefore, the aim of the present study was to examine differences in AL between a conceptually strictly specified group of individuals suffering from burnout (BO group) and a healthy comparison group (HC group). METHODS After a multi-stage recruitment procedure with strict inclusion criteria based on burnout symptomatology and pathogenesis, the BO group (n = 56) was compared to the HC group (n = 65) regarding an index of AL. The AL-index included 14 parameters: high-sensitivity c-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), fibrinogen, d-dimer, plasminogen activator inhibitor 1 (PAI-1), glycosylated hemoglobin (HbA1c), high-density lipoprotein (HDL) cholesterol, total cholesterol to HDL cholesterol ratio (TC/HDL), dehydroepiandrosterone-sulphate (DHEA-S), systolic blood pressure (SBP), diastolic blood pressure (DBP), waist-hip ratio (WHR), and body fat percentage. RESULTS The BO group showed significantly higher AL-scores in comparison to the HC group. This effect remained significant after adjusting for sex, age, and smoking status. Additionally, burnout symptoms (assessed with the Maslach Burnout Inventory; MBI), MBI-subscales emotional exhaustion and depersonalization as well as chronic work stress (assessed with the effort-reward imbalance questionnaire) were significantly associated with higher AL-scores. CONCLUSIONS Consistent with our hypothesis, we detected higher AL-scores in the BO compared to the HC group, indicating a greater cumulative physiological burden in individuals suffering from burnout. Given the high heterogeneity in individuals experiencing burnout symptoms, future studies may focus on well-specified subgroups, when examining the association between burnout and psychophysiological dysregulations.
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Zisook S, Doran N, Mortali M, Hoffman L, Downs N, Davidson J, Fergerson B, Rubanovich CK, Shapiro D, Tai-Seale M, Iglewicz A, Nestsiarovich A, Moutier CY. Relationship between burnout and Major Depressive Disorder in health professionals: A HEAR report. J Affect Disord 2022; 312:259-267. [PMID: 35760197 DOI: 10.1016/j.jad.2022.06.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Burnout is a "normal" albeit concerning response to workplace stress, whereas Major Depressive Disorder (MDD) is a serious illness associated with impairment and suicide risk. Because of symptomatic overlap between the two conditions and MDD-associated stigma, individuals reporting work-related stress and depression often are "diagnosed" with burnout at the expense of recognizing and treating MDD. Our study aimed to leverage organizational implementation of the American Foundation of Suicide Prevention's Interactive Screening Program to elucidate relationships among burnout, depression, and other suicide risk factors. METHODS 2281 of about 30,000 (~7.6 %) medical trainees, staff, and faculty responded to an anonymous online stress and depression questionnaire. Respondents were grouped into four cohorts: screened positive for burnout alone (n = 439, 19 %), depression alone (n = 268, 12 %), both conditions (n = 759, 33 %), or neither condition (n = 817, 36 %), and compared on multiple measures of distress and other suicide risk factors. RESULTS Burnout alone and depression alone each predicted greater distress and suicide risk compared with neither condition. Depression was a stronger predictor than burnout and demonstrated a consistent association with other suicide risk factors regardless of whether burnout was present. In contrast, burnout was not consistently associated with other suicide risk factors when depression was present. LIMITATIONS The sample was limited to one state-supported academic medical center; to individuals who elected to take the online survey; and relied on a single item, non-validated measure of burnout. CONCLUSION When emotional distress is reported by healthcare workers, attention should not stop at "burnout," as burnout frequently comingles with clinical depression, a serious and treatable mental health condition.
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Affiliation(s)
- Sidney Zisook
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America.
| | - Neal Doran
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America
| | - Maggie Mortali
- American Foundation for Suicide Prevention, New York, NY, United States of America
| | - Laura Hoffman
- American Foundation for Suicide Prevention, New York, NY, United States of America
| | - Nancy Downs
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America
| | - Judy Davidson
- University of California San Diego Health and Research Scientist, Department of Psychiatry, University of California San Diego, United States of America
| | - Byron Fergerson
- UC San Diego Department of Anesthesiology and Veterans Affairs, San Diego Healthcare System, La Jolla, CA, United States of America
| | - Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States of America
| | - Desiree Shapiro
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America
| | - Ming Tai-Seale
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America
| | - Alana Iglewicz
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America; Veterans Affairs, San Diego Healthcare System, La Jolla, CA, United States of America
| | - Anastasiya Nestsiarovich
- University of California San Diego, Department of Psychiatry, La Jolla, CA, United States of America
| | - Christine Yu Moutier
- American Foundation for Suicide Prevention, New York, NY, United States of America
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Abstract
ABSTRACT Burnout is a topic of high public and research interest, but debate remains as to how the syndrome should best be defined, measured, and diagnosed. In this article, we overview how issues relating to burnout's definition and measurement as well as the debate surrounding its overlap with depression have led to ambiguity surrounding its diagnostic status. We argue for a broader conceptualization of burnout and detail why we position it as distinct from depression, before providing recommendations for clinicians when considering a burnout diagnosis. We highlight that all measures of burnout risk "false-positive" diagnoses and that they should more be viewed as screening strategies with a definitive diagnosis (of "burning out" or "being burnt out") requiring close clinical assessment and exclusion of alternate psychological and physical conditions.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Determining the direction of prediction of the association between parasympathetic dysregulation and exhaustion symptoms. Sci Rep 2022; 12:10648. [PMID: 35739224 PMCID: PMC9219378 DOI: 10.1038/s41598-022-14743-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
Stress-related exhaustion symptoms have a high prevalence which is only likely to increase further in the near future. Understanding the physiological underpinnings of exhaustion has important implications for accurate diagnosis and the development of effective prevention and intervention programs. Given its integrative role in stress-regulation, the parasympathetic branch of the autonomic nervous systems has been a valid starting point in the exploration of the physiological mechanisms behind exhaustion. The aim of the present study was to examine the directionality and specificity of the association between exhaustion symptoms and vagally-mediated heart rate variability (vmHRV), a relatively pure measure of parasympathetic tone. Exhaustion symptoms and vmHRV were measured at four annually assessment waves (2015-2018) of the Dresden Burnout Study. A total sample of N = 378 participants who attended at least two of the four annual biomarker measurements were included in the present analyses. Cross-lagged multi-level panel modelling adjusting for various covariates (e.g., age, sex, BMI) revealed that vmHRV was meaningfully predictive of exhaustion symptoms and not vice versa. In addition, these effects were specific for exhaustion symptoms as no effect was shown for the other burnout sub-dimensions, or for depressive symptoms. Our findings indicate a clear link between exhaustion symptoms and vmHRV which may hold great potential for both enhancing the diagnosis and treatment of exhaustion symptoms.
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Westphal M, Wall M, Corbeil T, Keller DI, Brodmann-Maeder M, Ehlert U, Exadaktylos A, Bingisser R, Kleim B. Mindfulness predicts less depression, anxiety, and social impairment in emergency care personnel: A longitudinal study. PLoS One 2021; 16:e0260208. [PMID: 34910763 PMCID: PMC8673595 DOI: 10.1371/journal.pone.0260208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022] Open
Abstract
Medical personnel working in emergency rooms (ER) are at increased risk of mental health problems and suicidality. There is increasing evidence that mindfulness-based interventions can improve burnout and other mental health outcomes in health care providers. In contrast, few longitudinal prospective studies have examined protective functions of dispositional mindfulness in this population. The objective of this study was to examine whether mindfulness prospectively predicts anxiety, depression, and social impairment in a sample of emergency care professionals. The authors administered online surveys to ER personnel prior to work in ER, and at 3 and 6 months follow up. Participants were 190 ER personnel (73% residents, 16% medical students, 11% nurses). Linear mixed effects regression was used to model longitudinal 3-month and 6-month follow up of depression, anxiety, and social impairment. Predictors included time-varying contemporaneous work stressors, perceived social support at work and life events, and baseline dispositional mindfulness, demographics, and workplace characteristics. Mindfulness indexed when starting ER work predicted less depression, anxiety, and social impairment 6 months later. Mindfulness remained a strong predictor of mental health outcomes after controlling for time-varying stressful events in emergency care, negative life events, and social support at work. Mindfulness moderated the adverse impact of poor social support at work on depression. To our knowledge, this is the first longitudinal study to show that mindfulness prospectively and robustly predicts anxiety, depression, and social impairment. Results support the role of mindfulness as a potential resilience factor in at-risk health care providers.
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Affiliation(s)
- Maren Westphal
- Department of Psychology, Pace University, Pleasantville, New York, United States of America
- Department of Psychiatry, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Melanie Wall
- Department of Biostatistics, Columbia University, New York, New York, United States of America
| | - Thomas Corbeil
- Department of Biostatistics, Columbia University, New York, New York, United States of America
| | - Dagmar I. Keller
- Department of Emergency Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Monika Brodmann-Maeder
- Department of Emergency Medicine, Inselspital—University Hospital Bern, Bern, Switzerland
| | - Ulrike Ehlert
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | | | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Birgit Kleim
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
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11
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Tu Z, He J, Zhou N, Shen X. Driver-passenger communicative stress and psychological distress among Chinese bus drivers: the mediating effect of job burnout. BMC Public Health 2021; 21:547. [PMID: 33743660 PMCID: PMC7980616 DOI: 10.1186/s12889-021-10618-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/10/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between driver-passenger communicative stress and psychological distress among bus drivers, as well as whether job burnout mediates the effect of driver-passenger communicative stress on psychological distress. METHODS A questionnaire consisting of a 12-item version of the General Health Questionnaire (GHQ-12), a one-item driver-passenger communicative stress scale, the Maslach Burnout Inventory-General Survey (MBI-GS), as well as sociodemographic and work factors, was distributed to 310 bus drivers in Shanghai, of which 307 completed it (99.0% response rate). A parallel multiple mediation model with bootstrap approach, was calculated to test the mediating effect. RESULTS Driver-passenger communicative stress, emotional exhaustion and cynicism were positively associated with psychological distress. Communicative stress was significantly positively linked with two of the three dimensions of burnout (emotional exhaustion and cynicism) and dependent variable. Emotional exhaustion and cynicism were positively associated with the dependent variable. The results indicate that emotional exhaustion and cynicism partially mediated the effect of communicative stress on psychological health, and that 60.0% of this effect can be explained by mediating effects, in which emotional exhaustion and cynicism weighed 63.2% and 36.8%, respectively. CONCLUSIONS Communicative stress had effects on psychological distress among Chinese bus drivers, and job burnout was a mediator in this relationship.
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Affiliation(s)
- Zhihao Tu
- Department of Nautical psychology, Faculty of Psychology, The Second Military Medical University, Shanghai, China
| | - Jingwen He
- Department of Medical Psychology, NO.96609 Hospital, Yinchuan, China
| | - Na Zhou
- Mental health education center, Facult of Psychology, The Second Military Medical University, Shanghai, China.
| | - Xinghua Shen
- Department of Nautical psychology, Faculty of Psychology, The Second Military Medical University, Shanghai, China.
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12
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Sjörs Dahlman A, Jonsdottir IH, Hansson C. The hypothalamo-pituitary-adrenal axis and the autonomic nervous system in burnout. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:83-94. [PMID: 34266613 DOI: 10.1016/b978-0-12-819973-2.00006-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Burnout constitutes a serious health concern in the modern working environment. It is a stress-related condition that has developed as a result of a prolonged psychosocial stress exposure causing a persistent mismatch between demands and resources. The main symptom is emotional exhaustion, but physical fatigue, diminished professional efficacy, cynicism, and cognitive impairments are also associated with this condition. Burnout has been used both as a psychologic term in occupational settings and as a clinical diagnosis in patient populations, and there is currently no universally accepted definition and diagnostic criteria of burnout. It has been hypothesized that the two main stress response systems, the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal axis (HPA axis), are involved in the pathogenesis of burnout. A common hypothesis is that in the early stages of chronic stress, the HPA axis and sympathetic ANS activity tend to be higher, while it will decrease with a longer duration of chronic stress to ultimately reach a state of hypoactivity in clinical burnout. The current research in this field shows many contradictory results. Thus there is no compelling evidence of either ANS or HPA dysfunction in burnout. However, there is partial support for the hypothesis of HPA and sympathetic hyperactivity in early stages, and HPA hyporeactivity and low vagal activity in more severe burnout cases, but high-quality studies investigating the causal links are still lacking.
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Affiliation(s)
- Anna Sjörs Dahlman
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Human Factors Department, Swedish National Road and Transport Research Institute, Gothenburg, Sweden.
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Hansson
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Orosz A, Federspiel A, Eckert A, Seeher C, Dierks T, Tschitsaz A, Cattapan K. Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress. Clin Psychol Psychother 2020; 28:852-861. [PMID: 33283948 DOI: 10.1002/cpp.2539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.
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Affiliation(s)
- Ariane Orosz
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Andrea Federspiel
- University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Anne Eckert
- Neurobiology Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform Molecular and Cognitive Neuroscience (MCN), University of Basel, Psychiatric University Clinics Basel, Basel, Switzerland
| | - Christian Seeher
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland
| | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
| | - Armita Tschitsaz
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy Bern, Moosseedorf, Switzerland
| | - Katja Cattapan
- Centre for Stress-Related Illnesses, Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Bern Psychiatric Services (UPD), Bern, Switzerland
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Buruck G, Pfarr AL, Penz M, Wekenborg M, Rothe N, Walther A. The Influence of Workload and Work Flexibility on Work-Life Conflict and the Role of Emotional Exhaustion. Behav Sci (Basel) 2020; 10:bs10110174. [PMID: 33207774 PMCID: PMC7697797 DOI: 10.3390/bs10110174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to examine the relationship between contextual work-related factors in terms of job demands (workload—WL) and job resources (work flexibility—WF), work–life conflict (WLC) and the burnout dimension emotional exhaustion (EE) in a large population-based sample. Building on the job demands resources model (JDRM), we have developed the hypothesis that WL has an indirect effect on EE that is mediated by WLC. We conducted a secondary analysis using data from the Dresden Burnout Study (DBS, N = 4246, mean age (SD) = 42.7 years (10.5); 36.4% male). Results from structural equation modelling revealed that EE is positively associated with WL (β = 0.15, p = 0.001) and negatively associated with WF (β = −0.13, p = 0.001), also after accounting for potential confounding variables (demography, depressive symptoms, and lifetime diagnosis of burnout). Both effects are mediated by WLC (β = 0.18; p = 0.001 and β = 0.08; p = 0.001, respectively) highlighting the important role of WLC in employee health. In summary, WF may help to reduce burnout symptoms in employees, whereas WL may increase them. Study results suggest that both associations depend on WLC levels.
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Affiliation(s)
- Gabriele Buruck
- Professor for health promotion and prevention, Faculty of Health and Healthcare Sciences, University of Applied Sciences Zwickau, 08056 Zwickau, Germany;
- Correspondence:
| | - Anna-Lisa Pfarr
- Professor for health promotion and prevention, Faculty of Health and Healthcare Sciences, University of Applied Sciences Zwickau, 08056 Zwickau, Germany;
| | - Marlene Penz
- Institute for Education and Psychology, University of Applied Sciences, 4040 Linz, Austria;
| | - Magdalena Wekenborg
- Institute of Biopsychology, Faculty of Psychology, Technische Universität Dresden, 01069 Dresden, Germany; (M.W.); (N.R.)
| | - Nicole Rothe
- Institute of Biopsychology, Faculty of Psychology, Technische Universität Dresden, 01069 Dresden, Germany; (M.W.); (N.R.)
| | - Andreas Walther
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, 8006 Zürich, Switzerland;
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Bakusic J, Ghosh M, Polli A, Bekaert B, Schaufeli W, Claes S, Godderis L. Epigenetic perspective on the role of brain-derived neurotrophic factor in burnout. Transl Psychiatry 2020; 10:354. [PMID: 33077716 PMCID: PMC7573604 DOI: 10.1038/s41398-020-01037-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays a potential role in the neurobiology of burnout, but there are no studies investigating the underlying genetic and epigenetic mechanisms. Our aim is to further explore the role of BDNF in burnout, by focusing on the Val66Met polymorphism and methylation patterns of the BDNF gene and serum BDNF (sBDNF) protein expression. We conducted a cross-sectional study by recruiting 129 individuals (59 with burnout and 70 healthy controls). Participants underwent a clinical interview, psychological assessment and blood sample collection. Polymorphism and DNA methylation were measured on DNA from whole blood, using pyrosequencing and sBDNF levels were measured using ELISA. We found significantly increased methylation of promoter I and IV in the burnout group, which also correlated with burnout symptoms. In addition, DNA methylation of promoter I had a significant negative effect on sBDNF. For DNA methylation of exon IX, we did not find a significant difference between the groups, nor associations with sBDNF. The Val66Met polymorphism neither differed between groups, nor was it associated with sBDNF levels. Finally, we did not observe differences in sBDNF level between the groups. Interestingly, we observed a significant negative association between depressive symptoms and sBDNF levels. The current study is the first to show that BDNF DNA methylation changes might play an important role in downregulation of the BDNF protein levels in burnout. The presence of depressive symptoms might have an additional impact on these changes.
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Affiliation(s)
- Jelena Bakusic
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Manosij Ghosh
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Andrea Polli
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bram Bekaert
- grid.5596.f0000 0001 0668 7884Department of Forensic Medicine, Laboratory of Forensic Genetics and Molecular Archaeology; KU Leuven, Leuven, Belgium
| | - Wilmar Schaufeli
- grid.5596.f0000 0001 0668 7884Work, Organisational and Personnel Psychology, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- grid.5596.f0000 0001 0668 7884Psychiatry Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Lode Godderis
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium ,IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
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He SC, Wu S, Wang C, Wang DM, Wang J, Xu H, Wang L, Zhang XY. Interaction between job stress, serum BDNF level and the BDNF rs2049046 polymorphism in job burnout. J Affect Disord 2020; 266:671-677. [PMID: 32056943 DOI: 10.1016/j.jad.2020.01.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/15/2019] [Accepted: 01/31/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Some studies have shown that long-term exposure to job stress could result in burnout, and BDNF polymorphism may play an important role in its psychopathological mechanism. However, the inter-relationships between the job-related stress, serum BDNF level, BDNF genotype and job burnout have not been examined. This study was to explore the job stress × BDNF rs2049046 interaction and the role of serum BDNF level in job burnout in a Chinese Han population. METHODS Using a cross-sectional design, 205 healthy subjects were recruited from a public institution in Beijing and assessed for job stress using the House and Rizzo's Work Stress Scale, and job burnout using the Maslach Burnout Inventory (MBI). The BDNF rs2049046 polymorphism was genotyped and serum BDNF (sBDNF) levels were assayed in all of subjects. RESULTS The correlations between the job stress score and two burnout subscale scores (emotional exhaustion and cynicism) were significant (both p < 0.001), but not with professional efficacy. There were no significant main effects of the BDNF rs2049046 genotype on burnout, and no significant correlation was observed between sBDNF levels and job burnout. However, the interaction between the job stress and the BDNF rs2049046 genotype (F = 2.709, df = 2, 183, p = 0.032) or between the job stress and sBDNF levels on burnout was significant (t = -2.132, p = 0.035). To be specific, the individuals with the BDNF rs2049046 AT genotype showed a greater susceptibility to the burnout cynicism compared to AA homozygote only in medium-stress group (F = 4.327, df = 1,117, p = 0.015). The individuals who had lower sBDNF showed higher burnout level than those who had higher sBDNF in low-stress group. CONCLUSIONS Our findings suggest that the BDNF system may interact with job stress to affect burnout, showing that interaction between BDNF rs2049046 and job stress or the interaction between BDNF levels with work stress on certain burnout dimensions.
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Affiliation(s)
- Shu-Chang He
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian district, 100871 Beijing, China.
| | - Shuang Wu
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian district, 100871 Beijing, China
| | - Chao Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian district, 100871 Beijing, China
| | - Dong-Mei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China.
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Romito BT, Okoro EN, Ringqvist JRB, Goff KL. Burnout and Wellness: The Anesthesiologist's Perspective. Am J Lifestyle Med 2020; 15:118-125. [PMID: 33786030 DOI: 10.1177/1559827620911645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022] Open
Abstract
Burnout syndrome results from unmanaged chronic workplace stress. It is characterized by emotional exhaustion, lack of a sense of personal accomplishment, and depersonalization. Burnout is associated with the development of poor work-related outcomes, mental health disorders, substance abuse, and cardiovascular disease. Burnout in physicians and other health care providers can negatively affect patient care. The prevalence of burnout in anesthesiology is among the highest of all medical specialties, with rates approaching 40%. Unique risk factors for the development of burnout in anesthesiologists may include environmental social isolation, long work hours, lack of control over one's career, and the presence of certain personality traits that select for a career in anesthesia. System-based interventions targeting workplace contributions to burnout and individual resilience and mindfulness training can be helpful in reducing burnout symptoms. Future research efforts examining both the health care environmental structure and the specific burnout risk factors for anesthesiologists will help produce targeted treatment strategies for members of the anesthesiology community.
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Affiliation(s)
- Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ejike N Okoro
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jenny R B Ringqvist
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kristina L Goff
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Is it all about Depression? Determinants of Burnout among Employees Referred for Inpatient Treatment of Job-Related Stress Disorders. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 65:183-197. [PMID: 31154931 DOI: 10.13109/zptm.2019.65.2.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: There is an ongoing debate as to whether job burnout and depression are overlapping concepts or differ from each other, although this has not been scrutinized in inpatients. To further elucidate the robustness of this relationship, we used three different measurements of depression. We further examined the influence of psychological distress, perceived stress and sleep quality in the link between depressive symptoms and burnout. Methods: We investigated 723 consecutive inpatients, aged 23 to 82 years, 51.2 % women, referred to a hospital specialized in the treatment of job stress-related disorders. Patients completed the Maslach Burnout Inventory, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Results: We found significant correlations between burnout total scores as well as subscales (emotional exhaustion, depersonalization, lack of accomplishment) and depressive symptoms, virtually independent of the applied depression measure. The shared variance ranged between 1.1 % and 19.4 %. Greater levels of burnout were directly associated with cognitiveaffective symptoms and, although to a lesser extent, also with somatic-affective symptoms of depression. In the multivariable analysis, significantly more total burnout symptoms were revealed in more depressed and younger patients, in men than women, and in employees with greater levels of psychological distress and perceived stress, respectively. Conclusions: The findings suggest that although burnout and depression do not represent the same psychopathology, there is considerable overlap between the two constructs; the extent of this overlap may vary depending upon the applied depression measure.
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19
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Riethof N, Bob P, Laker M, Varakova K, Jiraskova T, Raboch J. Burnout Syndrome, Mental Splitting and Depression in Female Health Care Professionals. Med Sci Monit 2019; 25:5237-5240. [PMID: 31302661 PMCID: PMC6647923 DOI: 10.12659/msm.915360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The early days of a given experience are associated with typically what might be characterized as an idealized enthusiasm. Conversely burnout syndrome experienced later in the given experience is associated with disillusionment, disappointment, and symptoms which resemble a depression. This very common propensity is a parallel to the concept of “splitting” described by Kernberg with a pronounced “black and white” perceptual dichotomy between the early idealization and later disillusionment. This study intends examination of relationships between burnout syndrome, depression, and Kernberg’s concept of splitting. Material/Methods In this present study, we assessed 132 female health care professionals working with a population of diabetic patients utilizing Burnout Measure (BM) Splitting Index (SI), Beck Depression Inventory II (BDI-II), and additional psychometric instruments, the Toronto Alexithymia Scale and the Trauma Symptoms Checklist. Results The study results indicated significant Spearman correlations between burnout syndrome as measured by BM and depression (BDI-II) (R=0.62, P<0.01), and burnout syndrome as measured by BM and splitting (SI) (R=0.45, P<0.01). These findings may have implications for prevention and treatment of burnout syndrome. Conclusions The current study findings provide implications that the defensive mechanism of splitting may allow for the prediction of burnout symptoms which in turn may allow for the prediction of burnout syndrome. This dynamics may potentially be of use in both the potential detection and prevention of burnout syndrome.
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Affiliation(s)
- Norbert Riethof
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Bob
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Central European Institute of Technology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Matthew Laker
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Varakova
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Terezie Jiraskova
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Raboch
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
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20
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Wehmeier PM, Fox T, Doerr JM, Schnierer N, Bender M, Nater UM. Development and Validation of a Brief Measure of Self-Management Competence: The Self-Management Self-Test (SMST). Ther Innov Regul Sci 2019:2168479019849879. [PMID: 31303020 DOI: 10.1177/2168479019849879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Self-management can be considered a way of dealing with oneself and relates to actions undertaken to create order, discipline, and control. The concept is closely linked to concepts of self-efficacy and self-regulation but can be distinguished from these. The Self-Management Self-Test (SMST) is a 5-item assessment scale designed to measure self-management competence in individuals with or without a psychiatric disorder (as screened using PHQ). The aim of this study was to validate the SMST in terms of convergent validity, the ability to differentiate, criterion validity, internal consistency, and test-retest reliability. METHODS Eighty-seven adults hospitalized for treatment of major depression (clinical sample) and 595 individuals from the general population (population sample) filled out the SMST and 5 other stress-related psychometric instruments measuring similar constructs. All instruments were repeated 4 to 6 weeks later. Convergent validity, internal consistency, and test-retest reliability were tested based on data from the population sample. Convergent validity was determined by correlations with other stress-related psychometric instruments. Correlations in the range of r = -0.4 to -0.6 were expected. To test for criterion validity, the clinical sample was matched with a subsample from the population sample, consisting only of individuals without a psychiatric disorder as screened using PHQ (nonclinical subsample, n = 87). The ability to differentiate was based on receiver operating characteristic (ROC) curve analysis. RESULTS Correlations between the SMST and the other stress-related tests were significant and in the expected direction and predominantly within the expected range (Pearson r = -0.40 to -0.64). The correlation with the Multidimensional Fatigue Inventory-20, measuring fatigue, and with the dimensional scale for depression in the PHQ was higher than expected and referred to very similar items. Thus, convergent validity mainly lay within the expected range. Internal consistency was high (Cronbach α = 0.80), and test-retest reliability was fairly low (r = 0.71). The SMST showed a significant difference, t(157) = 7.97, P < .001, between the clinical sample (M = 9.36, SD = 3.39) and the nonclinical subsample (M = 12.94, SD = 2.47) with a large effect size (d = 1.3). The area under the ROC curve (AUC) was excellent (AUC = 0.81, SE = 0.034, P < .001), suggesting that the SMST can distinguish between the clinical and nonclinical samples. CONCLUSIONS The SMST can be considered an effective self-rating test to assess self-management competence in individuals from the general population as well as in people with major depression. It may also be useful to detect treatment outcomes in people with major depression. The high internal consistency indicates that all 5 items are important for the test as a whole. The low test-retest reliability suggests sensitivity to change. The SMST is likely to differentiate particularly well at low levels of self-management competence, suggesting it may be a useful tool in studies investigating people with depression or other psychiatric disorders such as post-traumatic stress disorder. Furthermore, the SMST could be useful in assessing the effect of treatment interventions over time and evaluating patient-reported outcomes.
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Affiliation(s)
- Peter M Wehmeier
- 1 Vitos Hospital for Psychiatry and Psychotherapy, Weilmuenster, Germany
| | - Theresa Fox
- 2 Department of Psychology, University of Berlin, Berlin, Germany
| | - Johanna M Doerr
- 3 Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- 4 Department of Psychology, University of Marburg, Marburg, Germany
| | - Nadja Schnierer
- 1 Vitos Hospital for Psychiatry and Psychotherapy, Weilmuenster, Germany
| | - Matthias Bender
- 5 Vitos Hospital for Psychiatry and Psychotherapy, Kassel, Germany
| | - Urs M Nater
- 6 Department of Psychology, University of Vienna, Vienna, Austria
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Fitzpatrick O, Biesma R, Conroy RM, McGarvey A. Prevalence and relationship between burnout and depression in our future doctors: a cross-sectional study in a cohort of preclinical and clinical medical students in Ireland. BMJ Open 2019; 9:e023297. [PMID: 31048421 PMCID: PMC6502268 DOI: 10.1136/bmjopen-2018-023297] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This cross-sectional study was designed to measure burnout and its impact on risk of depression in a medical student population, comparing the preclinical and clinical years. DESIGN We conducted a survey of 269 medical school students in both preclinical and clinical years at the Royal College of Surgeons in Ireland, using the Beck Depression Inventory-Fast Screen (BDI-FS), the Maslach Burnout Inventory-Student Survey and items assessing willingness to use mental health services. Burnout scores were calibrated to probability of depression caseness and classified as low risk (<25%), intermediate (25%-50%) and high risk (>50%) of depression. RESULTS There was a 39% (95% CI 33% to 45%) prevalence of depressive caseness based on a score of ≥6 on the BDI-FS. Prevalence did not vary significantly between clinical and preclinical years. The rate of burnout varied significantly between years (p=0.032), with 35% in the high-burnout category in clinical years compared with 26% in preclinical years. Those in the low burnout category had a 13% overall prevalence of depressive symptoms, those in the intermediate category had a 38% prevalence and those in the high category had a 66% prevalence of depressive symptoms. Increasing emotional exhaustion (OR for one-tertile increase in score 2.0, p=0.011) and decreasing academic efficacy (OR 2.1, p=0.007) increased the odds of being unwilling to seek help for mental health problems (11%). CONCLUSION While previous studies have reported significant levels of burnout and depression, our method of calibrating burnout against depression allows burnout scores to be interpreted in terms of their impact on mental health. The high prevalences, in line with previous research, point to an urgent need to rethink the psychological pressures of health professions education.
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Affiliation(s)
- Orla Fitzpatrick
- Public health, Royal College of Surgeons in Ireland School of Medicine, Dublin, Ireland
| | - Regien Biesma
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronán M Conroy
- Epidemiology Department, Royal College of Surgeons, Dublin, Ireland
| | - Alice McGarvey
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
OBJECTIVE Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms. METHODS Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart. RESULTS In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = -.16; p = .03) and EE (β = -.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = -.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2. CONCLUSIONS We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.
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Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci 2018; 12:397. [PMID: 30356789 PMCID: PMC6189422 DOI: 10.3389/fnhum.2018.00397] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 12/25/2022] Open
Abstract
Contemplative practices, such as meditation and yoga, are increasingly popular among the general public and as topics of research. Beneficial effects associated with these practices have been found on physical health, mental health and cognitive performance. However, studies and theories that clarify the underlying mechanisms are lacking or scarce. This theoretical review aims to address and compensate this scarcity. We will show that various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline in turn could parsimoniously explain the physical and mental benefits of contemplative activities through changes in autonomic balance. We propose a neurophysiological model that explains how these specific respiration styles could operate, by phasically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation (rVNS). The vagal nerve, as a proponent of the parasympathetic nervous system (PNS), is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition. We will discuss implications and limitations of our model.
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Affiliation(s)
- Roderik J. S. Gerritsen
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Guido P. H. Band
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
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Zhang M, Liu L, Shi Y, Yang Y, Yu X, Angerer P, Kristensen TS, Li J. Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study. Gen Hosp Psychiatry 2018; 53:59-64. [PMID: 29859340 DOI: 10.1016/j.genhosppsych.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate longitudinal associations of burnout with heart rate variability (HRV) in patients after their first events of acute coronary syndrome (ACS). METHODS In total, two hundred eight patients participated in this one-year follow-up study. On the day before discharge, their personal burnout level was assessed by the Copenhagen Burnout Inventory. HRV signals were collected at four time points: the day before discharge, one month, six month and one year after discharge. HRV was measured by 24-hour ambulatory electrocardiography and analyzed in time and frequency domains. Generalized estimating equations were applied to analyze the associations of burnout at baseline with longitudinal tracking of HRV during follow-up in format of natural logarithmic transformation. RESULTS After adjusting for relevant confounding factors, high burnout at baseline was significantly associated with low standard deviation of NN intervals (SDNN), a time domain measure of HRV (p < 0.05). Also, baseline burnout was inversely associated with five frequency domain measures, i.e., high frequency power (HF), low frequency power (LF), very low frequency power (VLF), and ultra low frequency power (ULF), and total power (TP) (all p < 0.05). CONCLUSION Personal burnout is longitudinally associated with decreased HRV during one-year period among patients after first ACS.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Ling Liu
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yunke Shi
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yanfei Yang
- Cardiology Department, Kunming Children's Hospital, Kunming, Yunnan 650228, China
| | - Xiaoju Yu
- Cardiology Department, 1st hospital of Yibin City, Yibin, Sichuan 644000, China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
| | | | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
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Simionato GK, Simpson S. Personal risk factors associated with burnout among psychotherapists: A systematic review of the literature. J Clin Psychol 2018; 74:1431-1456. [DOI: 10.1002/jclp.22615] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Susan Simpson
- School of Psychology, Social Work, and Social Policy; University of South Australia
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Bianchi R, Schonfeld IS, Laurent E. Biological research on burnout-depression overlap: Long-standing limitations and on-going reflections. Neurosci Biobehav Rev 2017; 83:238-239. [PMID: 29079491 DOI: 10.1016/j.neubiorev.2017.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022]
Abstract
In this commentary, we discuss seldom-noticed methodological problems affecting biological research on burnout and depression and make recommendations to overcome the limitations of past studies conducted in this area. First, we suggest that identified subtypes of depression (e.g., depression with melancholic features and depression with atypical features) should be taken into account in future biological research on burnout and depression, given that different subtypes of depression have been associated with distinct autonomic and neuroendocrine profiles. Second, we underline that research on burnout-depression overlap is made difficult by the absence of a consensual conceptualization and operationalization of burnout. In order to resolve this problem, we draw researchers' attention to the urgency of establishing a commonly shared, clinically valid diagnosis for burnout. Finally, we question the possibility of identifying a biological signature for burnout in light of global research on burnout-depression overlap.
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Affiliation(s)
- Renzo Bianchi
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, NE, Switzerland.
| | - Irvin Sam Schonfeld
- The City College of the City University of New York, Department of Psychology, New York City, NY, United States
| | - Eric Laurent
- Bourgogne Franche-Comté University, Laboratory of Psychology (EA 3188), Besançon, France
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