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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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Trockel MT, Menon NK, Makowski MS, Wen LY, Roberts R, Bohman BD, Shanafelt TD. IMPACT: Evaluation of a Controlled Organizational Intervention Using Influential Peers to Promote Professional Fulfillment. Mayo Clin Proc 2023; 98:75-87. [PMID: 36464536 DOI: 10.1016/j.mayocp.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/15/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To determine the effects of a popular opinion leader (POL)-led organizational intervention targeting all physicians and advanced practice providers (APPs) working within clinic groups on professional fulfillment (primary outcome), gratitude, burnout, self-valuation, and turnover intent. PATIENTS AND METHODS All 20 Stanford University HealthCare Alliance clinics with ≥5 physicians-APPs were matched by size and baseline gratitude scores and randomly assigned to immediate or delayed intervention (control). Between July 10, 2018, and March 15, 2019, trained POLs and a physician-PhD study investigator facilitated 4 interactive breakfast or lunch workshops at intervention clinics, where colleagues were invited to discuss and experience one evidence-based practice (gratitude, mindfulness, cognitive, and behavioral strategies). Participants in both groups completed incentivized annual assessments of professional fulfillment, workplace gratitude, burnout, self-valuation, and intent to leave as part of ongoing organizational program evaluation. RESULTS Eighty-four (75%) physicians-APPs at intervention clinics attended at least 1 workshop. Of all physicians-APPs, 236 of 251 (94%) completed assessments in 2018 and 254 of 263 (97%) in 2019. Of 264 physicians-APPs with 2018 or 2019 assessment data, 222 (84%) had completed 2017 assessments. Modal characteristics were 60% female, 46% White, 49% aged 40 to 59 years, 44% practicing family-internal medicine, 78% living with partners, and 53% with children. Change in professional fulfillment by 2019 relative to average 2017 to 2018 levels was more favorable (0.63 points; effect size = 0.35; P=.001) as were changes in gratitude and intent to leave among clinicians practicing at intervention clinics. CONCLUSION Interventions led by respected physicians-APPs can achieve high participation rates and have potential to promote well-being among their colleagues.
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Affiliation(s)
| | - Nikitha K Menon
- Stanford University School of Medicine, Palo Alto, California
| | | | - Louise Y Wen
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Rachel Roberts
- Stanford University School of Medicine, Palo Alto, California
| | - Bryan D Bohman
- Stanford University School of Medicine, Palo Alto, California
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Thompson M, Carlson D, Crawford W, Kacmar KM, Weaver S. You Make Me Sick: Abuse at Work and Healthcare Utilization. HUMAN PERFORMANCE 2022. [DOI: 10.1080/08959285.2022.2104846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pijpker R, Veen EJ, Vaandrager L, Koelen M, Bauer GF. Developing an Intervention and Evaluation Model of Outdoor Therapy for Employee Burnout: Unraveling the Interplay Between Context, Processes, and Outcomes. Front Psychol 2022; 13:785697. [PMID: 35310237 PMCID: PMC8929413 DOI: 10.3389/fpsyg.2022.785697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Burnout is a major societal issue adversely affecting employees’ health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research. Aim The study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout. Methodological Approach We build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts. Results We identified six key outdoor intervention elements: (1) physical activity; (2) reconnecting body and mind; (3) nature metaphors; (4) creating relationships; (5) observing natural interactions; and (6) experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist (e.g., number of clients per day), therapy (e.g., privacy issues), and of the clients (e.g., affinity to nature). Conclusion The intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation.
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Affiliation(s)
- Roald Pijpker
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, Netherlands
| | - Esther J Veen
- Urban Food Issues, Aeres University of Applied Sciences, Almere, Netherlands
| | - Lenneke Vaandrager
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, Netherlands
| | - Maria Koelen
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, Netherlands
| | - Georg F Bauer
- Center of Salutogenesis, Division of Public and Organizational Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Arnsten AFT, Shanafelt T. Physician Distress and Burnout: The Neurobiological Perspective. Mayo Clin Proc 2021; 96:763-769. [PMID: 33673923 PMCID: PMC7944649 DOI: 10.1016/j.mayocp.2020.12.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Physician burnout and other forms of occupational distress are a significant problem in modern medicine, especially during the coronavirus disease pandemic, yet few doctors are familiar with the neurobiology that contributes to these problems. Burnout has been linked to changes that reduce a physician's sense of control over their own practice, undermine connections with patients and colleagues, interfere with work-life integration, and result in uncontrolled stress. Brain research has revealed that uncontrollable stress, but not controllable stress, impairs the functioning of the prefrontal cortex, a recently evolved brain region that provides top-down regulation over thought, action, and emotion. The prefrontal cortex governs many cognitive operations essential to physicians, including abstract reasoning, higher-order decision making, insight, and the ability to persevere through challenges. However, the prefrontal cortex is remarkably reliant on arousal state and is impaired under conditions of fatigue and/or uncontrollable stress when there are inadequate or excessive levels of the arousal modulators (eg, norepinephrine, dopamine, acetylcholine). With chronic stress exposure, prefrontal gray matter connections are lost, but they can be restored by stress relief. Reduced prefrontal cortex self-regulation may explain several challenges associated with burnout in physicians, including reduced motivation, unprofessional behavior, and suboptimal communication with patients. Understanding this neurobiology may help physicians have a more informed perspective to help relieve or prevent symptoms of burnout and may help administrative leaders to optimize the work environment to create more effective organizations. Efforts to restore a sense of control to physicians may be particularly helpful.
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Affiliation(s)
- Amy F T Arnsten
- Department of Neuroscience, Yale School of Medicine, New Haven, CT.
| | - Tait Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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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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Merces MCD, Coelho JMF, Lua I, Silva DDSE, Gomes AMT, Santana AIC, da Silva DAR, Neves Cunha Magalhães LB, Júnior AD. Burnout syndrome and metabolic syndrome: a cross-sectional population-based study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:266-274. [PMID: 33000694 DOI: 10.1080/19338244.2020.1819186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the population of Primary Health Care Nursing (PHC) professionals, the association between Burnout Syndrome (BS) and Metabolic Syndrome (MS) has not been investigated. The objective was to evaluate the association between BS and MS among PHC Nursing Professionals. A cross-sectional, multicenter, population-based study was conducted in the state of Bahia, Brazil, with 1,125 professionals. The prevalence of BS and MS corresponded to 18.3% and 24.4%, respectively. The prevalence in women of BS was 16.4% and of MS 23.7%, in men 31.6% for BS and 29.4% for MS. Men with BS are 3.23 times more likely to develop MS, and women 1.48 times more. BS was associated between men and women and exhibited a good discriminatory predictive power.
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Affiliation(s)
| | | | - Iracema Lua
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Douglas de Souza E Silva
- School of Medicine, Health Sciences Postgraduate Program, Federal University of Bahia, Salvador, Brazil
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Privitera MR. Human Factors/Ergonomics (HFE) in Leadership and Management: Organizational Interventions to Reduce Stress in Healthcare Delivery. Health (London) 2020. [DOI: 10.4236/health.2020.129091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Akimova EV, Akimov MY, Gakova EI, Kayumova MM, Gafarov VV, Kuznetsov VA. Psychosocial risk factors among young people of medium urban Siberian city: a gender aspect (according to a cross-sectional epidemiological study). КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- E. V. Akimova
- Tyumen Cardiology Research Center — branch of the Tomsk National Research Medical Center
| | | | - E. I. Gakova
- Tyumen Cardiology Research Center — branch of the Tomsk National Research Medical Center
| | - M. M. Kayumova
- Tyumen Cardiology Research Center — branch of the Tomsk National Research Medical Center
| | - V. V. Gafarov
- "Research Institute of Internal and Preventive Medicine — branch of the Federal Research Center Institute for Cytology and Genetics
| | - V. A. Kuznetsov
- Tyumen Cardiology Research Center — branch of the Tomsk National Research Medical Center
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Combined Interventions to Reduce Burnout Complaints and Promote Return to Work: A Systematic Review of Effectiveness and Mediators of Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010055. [PMID: 31861699 PMCID: PMC6981402 DOI: 10.3390/ijerph17010055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/03/2022]
Abstract
Burnout has adverse effects on the health and work-related outcomes of employees. Nevertheless, little is known about effective ways of reducing burnout complaints and facilitating full return to work, which defines rehabilitation. This study consists of a systematic review of the effects of combined interventions (i.e., both person-directed and organization-directed). It also includes the identification and description of mediators of change, thereby explaining how combined interventions do or do not work. Seven electronic databases were searched for English peer-reviewed publications: the Psychology and Behavioral Sciences Collection; PsycARTICLES; Web of Science; Scopus; SocINDEX; PubMed; and PsycINFO, using various combinations of search terms (e.g., burnout AND intervention). Out of 4110 abstracts published before 29 September, 2019, 10 studies (reporting the effects of nine combined interventions) fulfilled the inclusion criteria, which were defined using PICOS criteria (participants, interventions, comparators, outcomes and study design). Although the risk of bias of the included studies is high, all combined interventions were effective in facilitating rehabilitation. Results suggest that involving employees in decision-making and enhance their job control and social support, while eliminating stressors, explain the effectiveness of the intentions. With caution, workplace health promotion practitioners are encouraged to use these findings to tackle burnout among employees.
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Kim W, Bae M, Chang SJ, Yoon JH, Jeong DY, Hyun DS, Ryu HY, Park KS, Kim MJ, Kim C. Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH). J Prev Med Public Health 2019; 52:345-354. [PMID: 31795611 PMCID: PMC6893225 DOI: 10.3961/jpmph.19.116] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea. Methods A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling. Results Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081). Conclusions Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.
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Affiliation(s)
- Woojin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Munjoo Bae
- Department of Occupational and Environmental Health, Yonsei University Graduate School of Public Health, Seoul, Korea
| | - Sei-Jin Chang
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin-Ha Yoon
- Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Da Yee Jeong
- Department of Dental Hygiene, Hanyang Women's University, Seoul, Korea
| | - Dae-Sung Hyun
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.,Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
| | - Hye-Yoon Ryu
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Mi-Ji Kim
- Department of Preventive Medicine and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Korea
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Sairanen E, Lappalainen R, Lappalainen P, Kaipainen K, Carlstedt F, Anclair M, Hiltunen A. Effectiveness of a web-based Acceptance and Commitment Therapy intervention for wellbeing of parents whose children have chronic conditions: A randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Jonsdottir IH, Sjörs Dahlman A. MECHANISMS IN ENDOCRINOLOGY: Endocrine and immunological aspects of burnout: a narrative review. Eur J Endocrinol 2019; 180:R147-R158. [PMID: 30576285 PMCID: PMC6365671 DOI: 10.1530/eje-18-0741] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main endocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.
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Affiliation(s)
- Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
- Correspondence should be addressed to I H Jonsdottir;
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Sairanen E, Lappalainen P, Hiltunen A. Psychological inflexibility explains distress in parents whose children have chronic conditions. PLoS One 2018; 13:e0201155. [PMID: 30044852 PMCID: PMC6059465 DOI: 10.1371/journal.pone.0201155] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022] Open
Abstract
Experiential avoidance, cognitive defusion, and mindfulness have all been associated with psychological disorders and well-being. This study investigates whether they predict psychological distress, i.e., symptoms of burnout, depression, stress and anxiety, in parents of children with chronic conditions. We hypothesized that these factors would exhibit a large degree of common variance, and that when compared to mindfulness and defusion, experiential avoidance on its own would predict a larger proportion of unique variance. 75 parents of children with chronic conditions having burnout symptoms who participated in an intervention study completed measures of burnout, stress, anxiety, depression, experiential avoidance, cognitive defusion, and mindfulness at the beginning of the intervention study (baseline). We ran several regression analyses to assess the predictive ability of these different constructs. Experiential avoidance on its own accounted for 28–48% of the variance in different psychological symptoms. Cognitive defusion and mindfulness did not make a significant contribution to explaining burnout, stress and anxiety, but cognitive defusion contributed to explaining depression. The results confirmed our hypothesis, supporting research on the importance of psychological flexibility as a central factor in understanding the occurrence of psychological distress.
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Affiliation(s)
- Essi Sairanen
- Karlstad University, Department of Social and Psychological Studies, Karlstad, Sweden
- * E-mail:
| | - Päivi Lappalainen
- University of Jyväskylä, Department of Psychology, Jyväskylä, Finland
| | - Arto Hiltunen
- Karlstad University, Department of Social and Psychological Studies, Karlstad, Sweden
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Janssens H, Braeckman L, Vlerick P, Van de Ven B, De Clercq B, Clays E. The relation between social capital and burnout: a longitudinal study. Int Arch Occup Environ Health 2018; 91:1001-1009. [PMID: 30019175 DOI: 10.1007/s00420-018-1341-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Although social capital approach has showed its merits in predicting well-being and health in the working environment, studies examining the relation between social capital and burnout are scarce and limited to cross-sectional studies in the health care sector. This study aims to explore the longitudinal relationship between workplace social capital and burnout in a Belgian company in the energy sector. An additional aim was to assess whether the relation between workplace social capital and the dimensions of burnout was independent of job characteristics, i.e., the level of decision-making autonomy and task variety, and demographical variables. METHODS Analyses are conducted on the questionnaire data of 473 workers who participated at the two waves (2013 and 2014) of a longitudinal study. RESULTS The results showed a negative relation between social capital and distance and a positive relation between social capital and competence, after 1-year follow-up and after adjustments for baseline levels of the respective burnout dimension. In contrast with the literature, no relation between social capital and emotional exhaustion was found after adjustment for baseline level of emotional exhaustion. After additional adjustments were made for the job characteristics 'decision-making autonomy' and 'task variety', the relation between social capital and competence disappeared. CONCLUSIONS This study delivered evidence for the lagged relation between social capital and distance, even after controlling for demographical and job characteristics. Therefore, the findings suggest that organizations should pay attention to strategies enhancing social interaction, enabling to increase the levels of support, reciprocity, sharing and trust, in the prevention of burnout.
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Affiliation(s)
- Heidi Janssens
- Department of Public Health, Ghent University, Ghent, Belgium. .,Provikmo, Occupational Health Services, Dirk Martensstraat 26, B-8200, Bruges, Belgium.
| | | | - Peter Vlerick
- Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium
| | - Bart Van de Ven
- Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium
| | - Bart De Clercq
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health, Ghent University, Ghent, Belgium
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Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, de Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One 2017; 12:e0185781. [PMID: 28977041 PMCID: PMC5627926 DOI: 10.1371/journal.pone.0185781] [Citation(s) in RCA: 531] [Impact Index Per Article: 75.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Burnout is a syndrome that results from chronic stress at work, with several consequences to workers' well-being and health. This systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies. The PubMed, Science Direct, PsycInfo, SciELO, LILACS and Web of Science databases were searched without language or date restrictions. The Transparent Reporting of Systematic Reviews and Meta-Analyses guidelines were followed. Prospective studies that analyzed burnout as the exposure condition were included. Among the 993 articles initially identified, 61 fulfilled the inclusion criteria, and 36 were analyzed because they met three criteria that must be followed in prospective studies. Burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. The psychological effects were insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders and psychological ill-health symptoms. Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were identified as professional outcomes. Conflicting findings were observed. In conclusion, several prospective and high-quality studies showed physical, psychological and occupational consequences of job burnout. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.
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Affiliation(s)
| | | | - Arthur Eumann Mesas
- Department of Public Health, Universidade Estadual de Londrina, Paraná, Brazil
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Anclair M, Lappalainen R, Muotka J, Hiltunen AJ. Cognitive behavioural therapy and mindfulness for stress and burnout: a waiting list controlled pilot study comparing treatments for parents of children with chronic conditions. Scand J Caring Sci 2017; 32:389-396. [DOI: 10.1111/scs.12473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Malin Anclair
- Department of Social and Psychological Studies; Section of Psychology; Karlstad University; Karlstad Sweden
| | - Raimo Lappalainen
- Department of Psychology; University of Jyväskylä; Jyväskylä Finland
| | - Joona Muotka
- Department of Psychology; University of Jyväskylä; Jyväskylä Finland
| | - Arto J. Hiltunen
- Department of Social and Psychological Studies; Section of Psychology; Karlstad University; Karlstad Sweden
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Stress among surgical attending physicians and trainees: A quantitative assessment during trauma activation and emergency surgeries. J Trauma Acute Care Surg 2017; 81:723-8. [PMID: 27389128 DOI: 10.1097/ta.0000000000001162] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The adverse effects of stress on the wellness of trauma team members are well established; however, the level of stress has never been quantitatively assessed. The aim of our study was to assess the level of stress using subjective data and objective heart rate variability (HRV) among attending surgeons (ASs), junior residents (JRs) (PGY2/PGY3), and senior residents (SRs) (PGY5/PGY6) during trauma activation and emergency surgery. METHODS We preformed a prospective study enrolling participants over eight 24-hour calls in our Level I trauma center. Stress was assessed based on decrease in HRV, which was recorded using body worn sensors. Stress was defined as HRV of less than 85% of baseline HRV. We collected subjective data on stress for each participant during calls. Three groups (ASs, JRs, SRs) were compared for duration of different stress levels through trauma activation and emergency surgery. RESULTS A total of 22 participants (ASs: n = 8, JRs: n = 7, SRs: n = 7) were evaluated over 192 hours, which included 33 trauma activations and 50 emergency surgeries. Stress level increased during trauma activations and operations regardless of level of training. The ASs had significantly lower stress when compared with SRs and JRs during trauma activation (21.9 ± 10.7 vs. 51.9 ± 17.2 vs. 64.5 ± 11.6; p < 0.001) and emergency surgery (30.8 ± 7.0 vs. 53.33 ± 6.9 vs. 56.1 ± 3.8; p < 0.001). The level of stress was similar between JRs and SRs during trauma activation (p = 0.37) and emergency surgery (p = 0.19). There was no correlation between objectively measured stress level and subjectively measured stress using State-Trait Anxiety Inventory (R = 0.16; p = 0.01) among surgeons or residents. CONCLUSIONS Surgeon wellness is a significant concern, and this study provides empirical evidence that trauma and acute care surgeons encounter mental strain and fail to recognize it. Stress management and burnout are very important in this high-intensity field, and this research may provide some insight in finding those practitioners who are at risk. LEVEL OF EVIDENCE Epidemiologic study, level II.
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Abstract
OBJECTIVE The construct of vital exhaustion has been identified as a potential independent psychological risk factor for incident and recurrent coronary heart disease (CHD). Despite several decades of research, no systematic review or meta-analysis has previously attempted to collate the empirical evidence in this field. The purpose of this study was to review and quantify the impact of vital exhaustion on the development and progression of CHD. METHODS Prospective and case-control studies reporting vital exhaustion at baseline and CHD outcomes at follow-up were derived from PubMed, PsycINFO (1980 to July 2015; articles in English and published articles only), and bibliographies. Information on aim, study design, sample size, inclusion and exclusion criteria, assessment methods of psychological risk factors, and results of crude and adjusted regression analyses were abstracted independently by two authors. RESULTS Thirteen prospective (n = 52,636) and three case-control (cases, n = 244; controls, n = 457) studies assessed vital exhaustion and could be summarized in meta-analyses. The pooled adjusted risk of CHD in healthy populations was 1.50 (95% confidence interval [CI] = 1.22-1.85) for prospective studies, and 2.61 (95% CI = 1.66-4.10) for case-control studies using hospital controls. Risk of recurrent events in patients with CHD was 2.03 (95% CI = 1.54-2.68). The pooled adjusted risk of chronic heart failure in healthy populations was 1.37 (95% CI = 1.21-1.56), but this was based on results from only two studies. CONCLUSIONS Vital exhaustion is associated with increased risk of incident and recurrent CHD.
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Anclair M, Hjärthag F, Hiltunen AJ. Cognitive Behavioural Therapy and Mindfulness for Health-Related Quality of Life: Comparing Treatments for Parents of Children with Chronic Conditions - A Pilot Feasibility Study. Clin Pract Epidemiol Ment Health 2017; 13:1-9. [PMID: 28217146 PMCID: PMC5301303 DOI: 10.2174/1745017901713010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 10/31/2016] [Accepted: 11/30/2016] [Indexed: 01/11/2023]
Abstract
Background:
Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders. Objective: The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions. Method: The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months. Results: The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner. Conclusion: The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.
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Affiliation(s)
- Malin Anclair
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad, Sweden
| | - Fredrik Hjärthag
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad, Sweden
| | - Arto Juhani Hiltunen
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad, Sweden
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Yadav A, Rani S, Singh S. Working “out-of-phase” with reference to chronotype compromises sleep quality in police officers. Chronobiol Int 2016; 33:151-60. [DOI: 10.3109/07420528.2015.1121876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Systematic review of the evidence of a relationship between chronic psychosocial stress and C-reactive protein. Mol Diagn Ther 2013; 17:147-64. [PMID: 23615944 DOI: 10.1007/s40291-013-0026-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION C-reactive protein (CRP) is an acute-phase reactant with an increasing number of clinical functions. Studies in recent years have identified several social, economic, demographic, and psychological factors that contribute to baseline inflammation. Psychosocial stress represents a significant contributor to baseline inflammation. Given the importance of understanding background drivers of CRP levels, we conducted this review to assess the impact of chronic psychosocial stress on CRP levels. METHODS Medline was searched through February 2013 for human studies examining CRP levels with respect to chronic psychosocial stress. RESULTS The initial search identified 587 articles from which 129 potentially appropriate articles were reviewed. Of these 129 articles, 41 articles were included in the review. These studies were published between 2003 and 2013. Of these studies, 6 analyzed employment stress, 2 analyzed unemployment stress, 6 analyzed burnout and vital exhaustion, 6 analyzed caregiver stress, 3 analyzed interpersonal stress, 17 analyzed socioeconomic position, and 2 analyzed discrimination. CONCLUSION We conclude that psychosocial stress significantly impacts CRP and should be considered when interpreting the meaning of CRP elevations.
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Abstract
OBJECTIVE Burnout is a negative affective state consisting of emotional exhaustion, physical fatigue, and cognitive weariness symptoms. This study was designed to evaluate prospectively the association between burnout and coronary heart disease (CHD) incidence and to test the possibility that this association is nonlinear. METHODS Participants were 8838 apparently healthy employed men and women, aged 19 to 67 years, who came for routine health examinations at the Tel Aviv Sourasky Medical Center. They were followed up for 3.4 years on average. Burnout was measured by the Shirom-Melamed Burnout Measure. CHD incidence was defined as a composite of acute myocardial infarction, diagnosed ischemic heart disease, and diagnosed angina pectoris. RESULTS During follow-up, we identified 93 new cases of CHD. Baseline levels of burnout were associated with an increased risk of CHD, after adjustment for various risk factors (hazard ratio = 1.41; 95% confidence interval = 1.08-1.85). In addition, we observed a significant threshold effect of burnout on CHD incidence. Participants who scored high on burnout (scores in the upper quintile of the Shirom-Melamed Burnout Measure scores distribution) had a higher risk (hazard ratio = 1.79; 95% confidence interval = 1.05-3.04) of developing CHD on follow-up compared with others. CONCLUSIONS Burnout is an independent risk factor for future incidence of CHD. Individuals with high levels of burnout (upper quintile) have a significantly higher risk of developing CHD compared with those with low levels of burnout.
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Ramey SL, Perkhounkova Y, Downing NR, Culp KR. Relationship of Cardiovascular Disease to Stress and Vital Exhaustion in an Urban, Midwestern Police Department. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/216507991105900504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored risk factors for cardiovascular disease (CVD) among 336 officers of a Midwestern police force. Instruments used included the Perceived Stress Scale, the Maastricht Questionnaire (measuring vital exhaustion), and a general Health Risk Appraisal. Rates of CVD, hypertension, and hypercholesterolemia were 3%, 28%, and 43%, respectively. The relative risk of hypercholesterolemia for male officers, compared to female officers, was 1.98 (95% confidence interval [CI], 1.10 to 3.56). The officers' average body mass index was 28.6 ( SD = 4.9), with 80% being overweight or obese. The average vital exhaustion score was higher for female officers than male officers ( p < .05). Bivariate relationships of CVD with perceived stress, vital exhaustion, and age were statistically significant (p < .05). When controlling for age, odds ratios were 1.20 (95% CI, 1.03 to 1.39; p< .05) for perceived stress and 1.31 (95% CI, 1.12 to 1.53; p < .01) for vital exhaustion.
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Ramey SL, Perkhounkova Y, Downing NR, Culp KR. Relationship of cardiovascular disease to stress and vital exhaustion in an urban, midwestern police department. ACTA ACUST UNITED AC 2011; 59:221-7. [PMID: 21534494 DOI: 10.3928/08910162-20110418-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 02/07/2011] [Indexed: 01/22/2023]
Abstract
This study explored risk factors for cardiovascular disease (CVD) among 336 officers of a Midwestern police force. Instruments used included the Perceived Stress Scale, the Maastricht Questionnaire (measuring vital exhaustion), and a general Health Risk Appraisal. Rates of CVD, hypertension, and hypercholesterolemia were 3%, 28%, and 43%, respectively. The relative risk of hypercholesterolemia for male officers, compared to female officers, was 1.98 (95% confidence interval [CI], 1.10 to 3.56). The officers' average body mass index was 28.6 (SD = 4.9), with 80% being overweight or obese. The average vital exhaustion score was higher for female officers than male officers (p < .05). Bivariate relationships of CVD with perceived stress, vital exhaustion, and age were statistically significant (p < .05). When controlling for age, odds ratios were 1.20 (95% CI, 1.03 to 1.39; p < .05) for perceived stress and 1.31 (95% CI, 1.12 to 1.53; p < .01) for vital exhaustion.
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Affiliation(s)
- Sandra L Ramey
- University of Iowa, College of Nuring and College of Public Health, Iowa City, IA 52242, USA.
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[Burnout and the quality of life of workers in food industry--a pilot study in Serbia]. VOJNOSANIT PREGL 2010; 67:705-11. [PMID: 20954408 DOI: 10.2298/vsp1009705a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Burnout syndrome as a consequence of a long stress at workplace can seriously disturb health and quality of life in exposed workers. It is necessary to have adequate burnout prevention and its detection. Worldwide much attention is paid to protect burnout and methods for its determination constantly improve. In Serbia there has not been a study of that kind yet. The aim of the study was to investigate burnout syndrome impact on the quality of life of workers in food industry in Nis, and to call attention of researchers in Serbia on this phenomenon, as well as to test probability of applying the original, standardized questionnaires (CBI, ComQolA5) to working population in Serbia. METHODS This study was performed in Nis within a period from 2008 to 2009 in the Institute for Workers Health Protection. A total of 489 workers were included in this study by the use of the standard questionnaire for burnout (CBI) and quality of life (ComQoL-A5). Scale confidence for measuring burnout and quality of life was determined by Cronbach alpha coefficient. ANOVA analysis was used for rating influence of burnout on the quality of life. RESULTS The values of Cronbach alpha coefficient showed a high confidence of the scale for measurement personal burnout (0.87), work-related burnout (0.86) and subjective quality of life (0.83). We detected increased scores as a result of personal burnout (60.0), as well as of work-related burnout (67.9). The workers suggested relationship with the family and friends as a very important part for their quality of life (10.8), health (9.8) and safety (8.0). Productivity (6.8), emotional well-being (6.6) and material property (4.5) had smaller influence on their quality of life. An increase in score of work-related burnout by 1 was statistically significantly related to decreasing inter scores for subjective quality of life in health (B = -0.097), relationship with family and friends (B = -0.048), safety (B = -0.061) and place in community (B = -0.105). A statistically significant relation between work-related burnout and subjective quality of life in productivity, material and emotional well-being was not determined. CONCLUSION There is a high score of both personal and work related burnout among manufacturing workers in food industry. A negative correlation between burnout and subjective quality of life was also proved impacting health and well-being of workers, but also their productivity. The questionnaires we used (CBI, ComQolA5) could be considered as reliable and valid instruments for testing burnout and quality of life in Serbia.
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Ahola K, Väänänen A, Koskinen A, Kouvonen A, Shirom A. Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study. J Psychosom Res 2010; 69:51-7. [PMID: 20630263 DOI: 10.1016/j.jpsychores.2010.01.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 12/17/2009] [Accepted: 01/05/2010] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Kirsi Ahola
- Finnish Institute of Occupational Health, Helsinki, Finland.
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Ahola K, Toppinen-Tanner S, Huuhtanen P, Koskinen A, Väänänen A. Occupational burnout and chronic work disability: an eight-year cohort study on pensioning among Finnish forest industry workers. J Affect Disord 2009; 115:150-9. [PMID: 18945493 DOI: 10.1016/j.jad.2008.09.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 09/22/2008] [Accepted: 09/22/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective was to explore if burnout, a syndrome from chronic work stress, predicts work disability during eight years among industrial employees. We investigated whether burnout would predict disability in initially healthy employees and all subgroups by the most common causes for disability. METHODS Of the participants in a company-wide survey (n=9705, 63%) performed in 1996, 8371 employees were identified and 7810 provided full information. The impact of burnout and its sub-dimensions, assessed with the Maslach Burnout Inventory-General Survey, on being granted register-based new disability pension till 2004 was analysed with Cox hazard regression and multinomial regression. The analyses were adjusted for socio-demographic factors, registered medication use, and self-reported chronic illness at baseline. RESULTS The hazard ratio (HR) for new disability pension was 3.8 (95% confidence interval CI 2.7-5.4) with severe burnout. The risk of severe burnout and severe exhaustion for work disability attenuated but remained significant after adjustments. The association between severe burnout and work disability was significant also in the subpopulation of employees without registered medication at baseline but not among employees healthy by self-report. Crude associations between burnout and all categories of cause-specific disability were significant. The exhaustion dimension predicted work disability due to mental and miscellaneous disorders after adjustments. LIMITATIONS A non-random one-branch sample was used. The final sample covered 50% of eligible employees. CONCLUSIONS In industrial work, burnout-related chronic work disability is general in nature. Burnout predicts work disability among healthy employees when health is assessed with registered use of medication but not when it is determined by self-report.
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Affiliation(s)
- K Ahola
- Finnish Institute of Occupational Health, Work Organizations, Helsinki, Finland.
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Kitaoka‐Higashiguchi K, Morikawa Y, Miura K, Sakurai M, Ishizaki M, Kido T, Naruse Y, Nakagawa H. Burnout and Risk Factors for Arteriosclerotic Disease: Follow‐up Study. J Occup Health 2009; 51:123-31. [DOI: 10.1539/joh.l8104] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Yuko Morikawa
- Department of Public HealthKanazawa Medical UniversityJapan
| | - Katsuyuki Miura
- Department of Health ScienceShiga University of Medical ScienceJapan
| | - Masaru Sakurai
- Department of Public HealthKanazawa Medical UniversityJapan
| | - Masao Ishizaki
- Department of Social and Environmental MedicineKanazawa Medical UniversityJapan
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Justo D, Arbel Y, Altberg G, Kinori M, Shirom A, Melamed S, Shapira I, Rogowski O. Inflammation markers in individuals with history of mental health crisis. Inflammation 2008; 31:254-9. [PMID: 18566879 DOI: 10.1007/s10753-008-9072-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The association between temporary emotional states and systemic inflammation has never been studied. We measured the levels of systemic inflammation markers in the peripheral blood of individuals with history of mental health crisis. Erythrocyte sedimentation rate (ESR), fibrinogen plasma level, high-sensitivity C-reactive protein (hs-CRP) serum level, and white blood cell count (WBCC) were measured for each individual during routine screening examinations. History of mental health crisis was self-reported. Individuals taking psychotropic agents were excluded. A total of 4,669 males and 2,576 females were included. One hundred forty-eight (2.0%) individuals (77 males and 71 females) reported a history of mental health crisis, and 7,097 (98.0%) individuals (4,592 males and 2,505 females) did not report a history of mental health crisis. After adjustment for multiple confounders which had been associated with elevated systemic inflammation markers, the levels of systemic inflammation markers were significantly higher among males with history of mental health crisis compared with males with no history of mental health crisis, including fibrinogen plasma levels (294+/-6.1 vs. 279+/-1.9 mg/dl, p=0.010), and WBCC (7.2+/-0.2 vs. 6.8+/-0.1 x 10(3) cells/dl, p=0.039). The levels of systemic inflammation markers were not significantly higher among females with history of mental health crisis compared with females with no history of mental health crisis. History of mental health crisis might be associated with systemic inflammation in males. This finding may be relevant to the pathophysiology of cardiovascular disease in males.
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Affiliation(s)
- Dan Justo
- Department of Internal Medicine D and the Institute for Special Medical Examinations (MALRAM), Sourasky Medical Center, 6 Weitzman Street, Tel-Aviv 64239, Israel.
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Langelaan S, Bakker AB, Schaufeli WB, van Rhenen W, van Doornen LJP. Is burnout related to allostatic load? Int J Behav Med 2008; 14:213-21. [PMID: 18001236 DOI: 10.1007/bf03002995] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Burnout has a negative impact on physical health, but the mechanisms underlying this relation remain unclear. To elucidate these mechanisms, possible mediating physiological systems or risk factors for adverse health in burned-out employees should be investigated. GOAL The aim of the present study among 290 Dutch managers was to explore whether allostatic load mediates the relationship between burnout and physical health. METHOD Burned-out managers, as identified with the Maslach Burnout Inventory General Survey (MBI-GS), were compared with a healthy control group with regard to their allostatic load. The allostatic load index included eight parameters: Body-mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), C-reactive protein (CRP), high-density lipoprotein (HDL), cholesterol, glycosylated hemoglobin (HbA1C) and glucose. RESULTS Contrary to expectations, burned-out managers did not differ from healthy managers with regard to their scores on the allostatic load index. An additional analysis, using groups of managers in the extreme deciles of exhaustion (the core symptom of burnout), did also not reveal differences in allostatic load. CONCLUSION Burnout seems not to be associated with this proxy measure of allostatic load. The mediating physiological mechanisms between burnout and objective physical health remain to be elucidated.
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Affiliation(s)
- Saar Langelaan
- Department of Psychology, Utrecht University, The Netherlands.
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Singh AR, Singh SA. Diseases of poverty and lifestyle, well-being and human development. Mens Sana Monogr 2008; 6:187-225. [PMID: 22013359 PMCID: PMC3190550 DOI: 10.4103/0973-1229.40567] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Revised: 10/12/2007] [Accepted: 01/26/2008] [Indexed: 01/08/2023] Open
Abstract
The problems of the haves differ substantially from those of the have-nots. Individuals in developing societies have to fight mainly against infectious and communicable diseases, while in the developed world the battles are mainly against lifestyle diseases. Yet, at a very fundamental level, the problems are the same-the fight is against distress, disability, and premature death; against human exploitation and for human development and self-actualisation; against the callousness to critical concerns in regimes and scientific power centres.While there has been great progress in the treatment of individual diseases, human pathology continues to increase. Sicknesses are not decreasing in number, they are only changing in type.The primary diseases of poverty like TB, malaria, and HIV/AIDS-and the often co-morbid and ubiquitous malnutrition-take their toll on helpless populations in developing countries. Poverty is not just income deprivation but capability deprivation and optimism deprivation as well.While life expectancy may have increased in the haves, and infant and maternal mortality reduced, these gains have not necessarily ensured that well-being results. There are ever-multiplying numbers of individuals whose well-being is compromised due to lifestyle diseases. These diseases are the result of faulty lifestyles and the consequent crippling stress. But it serves no one's purpose to understand them as such. So, the prescription pad continues to prevail over lifestyle-change counselling or research.The struggle to achieve well-being and positive health, to ensure longevity, to combat lifestyle stress and professional burnout, and to reduce psychosomatic ailments continues unabated, with hardly an end in sight.WE THUS REALISE THAT MORBIDITY, DISABILITY, AND DEATH ASSAIL ALL THREE SOCIETIES: the ones with infectious diseases, the ones with diseases of poverty, and the ones with lifestyle diseases. If it is bacteria in their various forms that are the culprit in infectious diseases, it is poverty/deprivation in its various manifestations that is the culprit in poverty-related diseases, and it is lifestyle stress in its various avatars that is the culprit in lifestyle diseases. It is as though poverty and lifestyle stress have become the modern "bacteria" of developing and developed societies, respectively.For those societies afflicted with diseases of poverty, of course, the prime concern is to escape from the deadly grip of poverty-disease-deprivation-helplessness; but, while so doing, they must be careful not to land in the lap of lifestyle diseases. For the haves, the need is to seek well-being, positive health, and inner rootedness; to ask science not only to give them new pills for new ills, but to define and study how negative emotions hamper health and how positive ones promote it; to find out what is inner peace, what is the connection between spirituality and health, what is well-being, what is self-actualisation, what prevents disease, what leads to longevity, how simplicity impacts health, what attitudes help cope with chronic sicknesses, how sicknesses can be reversed (not just treated), etc. Studies on well-being, longevity, and simplicity need the concerted attention of researchers.THE TASK AHEAD IS CUT OUT FOR EACH ONE OF US: physician, patient, caregiver, biomedical researcher, writer/journalist, science administrator, policy maker, ethicist, man of religion, practitioner of alternate/complementary medicine, citizen of a world community, etc. Each one must do his or her bit to ensure freedom from disease and achieve well-being.Those in the developed world have the means to make life meaningful but, often, have lost the meaning of life itself; those in the developing world are fighting for survival but, often, have recipes to make life meaningful. This is especially true of a society like India, which is rapidly emerging from its underdeveloped status. It is an ancient civilization, with a philosophical outlook based on a robust mix of the temporal and the spiritual, with vibrant indigenous biomedical and related disciplines, for example, Ayurveda, Yoga, etc. It also has a burgeoning corpus of modern biomedical knowledge in active conversation with the rest of the world. It should be especially careful that, while it does not negate the fruits of economic development and scientific/biomedical advance that seem to beckon it in this century, it does not also forget the values that have added meaning and purpose to life; values that the ancients bequeathed it, drawn from their experiential knowledge down the centuries.The means that the developed have could combine with the recipes to make them meaningful that the developing have. That is the challenge ahead for mankind as it gropes its way out of poverty, disease, despair, alienation, anomie, and the ubiquitous all-devouring lifestyle stresses, and takes halting steps towards well-being and the glory of human development.
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Affiliation(s)
| | - Shakuntala A. Singh
- Reader and Head, Dept. of Philosophy, Joshi-Bedekar College, Thane, India. Deputy Editor, Mens Sana Monographs, India
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Melamed S, Shirom A, Toker S, Shapira I. Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons. Psychosom Med 2006; 68:863-9. [PMID: 17132837 DOI: 10.1097/01.psy.0000242860.24009.f0] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This prospective study was designed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout, a unique affective response to combined exposure to chronic stressors. METHODS The study participants were 677 employed men and women who were followed up for 3 to 5 years (mean = 3.6 years) for the onset of diagnosed type 2 diabetes. Burnout was assessed by the Shirom-Melamed Burnout Measure with its three subscales: emotional exhaustion, physical fatigue, and cognitive weariness. RESULTS The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status. During the follow-up period, 17 workers developed type 2 diabetes. Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes (95% confidence interval [CI] = 1.19-2.85) even after adjusting for age, sex, body mass index, smoking, alcohol use, leisure time physical activity, initial job category, and follow-up duration. In a subsample of 507 workers, the relative risk of diabetes was found to be much higher after additional control for blood pressure levels (odds ratio = 4.32, 95% CI = 1.75-10.67), available only for this subsample. CONCLUSIONS These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals.
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Affiliation(s)
- Samuel Melamed
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
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Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull 2006; 132:327-53. [PMID: 16719565 DOI: 10.1037/0033-2909.132.3.327] [Citation(s) in RCA: 393] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, resulting from prolonged exposure to work-related stress. The authors review the accumulated evidence suggesting that burnout and the related concept of vital exhaustion are associated with increased risk of cardiovascular disease and cardiovascular-related events. The authors present evidence supporting several potential mechanisms linking burnout with ill health, including the metabolic syndrome, dysregulation of the hypothalamic-pituitary-adrenal axis along with sympathetic nervous system activation, sleep disturbances, systemic inflammation, impaired immunity functions, blood coagulation and fibrinolysis, and poor health behaviors. The association of burnout and vital exhaustion with these disease mediators suggests that their impact on health may be more extensive than currently indicated.
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Affiliation(s)
- Samuel Melamed
- Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.
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Honkonen T, Ahola K, Pertovaara M, Isometsä E, Kalimo R, Nykyri E, Aromaa A, Lönnqvist J. The association between burnout and physical illness in the general population--results from the Finnish Health 2000 Study. J Psychosom Res 2006; 61:59-66. [PMID: 16813846 DOI: 10.1016/j.jpsychores.2005.10.002] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 09/08/2005] [Accepted: 10/03/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The association between burnout and physical diseases has been studied very little. The purpose of this study was to examine the relationship between burnout and physical illness in a representative nationwide population health study. METHODS As a part of the "Health 2000 Study" in Finland, 3368 employees aged 30-64 years were studied. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Physical diseases were diagnosed in a comprehensive health examination by research physicians. RESULTS Physical illness was more common among subjects with burnout than others (64% vs. 54%, P<.0001), and the prevalence of diseases increased with the severity of burnout (P<.0001). Burnout was an important correlate of cardiovascular diseases among men (OR=1.35; 95% CI, 1.13-1.61) and musculoskeletal disorders among women (OR=1.22, 95% CI, 1.07-1.38) when adjusted for age, marital status, education, socioeconomic status, physical strenuousness of work, smoking, physical activity, alcohol consumption, body mass index, and depressive symptoms. The prevalence of musculoskeletal disorders and cardiovascular diseases increased with the severity of all three dimensions of burnout, that is, exhaustion (P<.0001 and P<.001, respectively), cynicism (P=.0001 and P<.001, respectively), and lack of professional efficacy (P<.01 and P<.0001, respectively). CONCLUSIONS Burnout is associated with musculoskeletal diseases among women and with cardiovascular diseases among men. These associations are not explained by sociodemographic factors, health behavior, or depression. Physical illnesses are associated with all three dimensions of burnout and not only with the exhaustion dimension. In the future, the causal relationships between burnout and physical diseases need to be investigated in prospective studies.
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Affiliation(s)
- Teija Honkonen
- Department of Psychology, Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland.
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Toker S, Shirom A, Shapira I, Berliner S, Melamed S. The association between burnout, depression, anxiety, and inflammation biomarkers: C-reactive protein and fibrinogen in men and women. J Occup Health Psychol 2006; 10:344-62. [PMID: 16248685 DOI: 10.1037/1076-8998.10.4.344] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Following the demonstrated association of employee burnout or vital exhaustion with several risk factors for cardiovascular disease (CVD) and CVD risk, the authors investigated the possibility that one of the mechanisms linking burnout with CVD morbidity is microinflammation, gauged in this study by high-sensitivity C-reactive protein (hs-CRP) and fibrinogen concentrations. Their sample included 630 women and 933 men, all apparently healthy, who underwent periodic health examinations. The authors controlled for possible confounders including 2 other negative affective states: depression and anxiety. In women, burnout was positively associated with hs-CRP and fibrinogen concentrations, and anxiety was negatively associated with them. In men, depression was positively associated with hs-CRP and fibrinogen concentrations, but not with burnout or anxiety. Thus, burnout, depression, and anxiety are differentially associated with microinflammation biomarkers, dependent on gender.
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Affiliation(s)
- Sharon Toker
- Faculty of Management, Tel Aviv University, Tel Aviv, Israel.
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van Vegchel N, de Jonge J, Bosma H, Schaufeli W. Reviewing the effort–reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med 2005; 60:1117-31. [PMID: 15589679 DOI: 10.1016/j.socscimed.2004.06.043] [Citation(s) in RCA: 393] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present paper provides a review of 45 studies on the Effort-Reward Imbalance (ERI) Model published from 1986 to 2003 (inclusive). In 1986, the ERI Model was introduced by Siegrist et al. (Biological and Psychological Factors in Cardiovascular Disease, Springer, Berlin, 1986, pp. 104-126; Social Science & Medicine 22 (1986) 247). The central tenet of the ERI Model is that an imbalance between (high) efforts and (low) rewards leads to (sustained) strain reactions. Besides efforts and rewards, overcommitment (i.e., a personality characteristic) is a crucial aspect of the model. Essentially, the ERI Model contains three main assumptions, which could be labeled as (1) the extrinsic ERI hypothesis: high efforts in combination with low rewards increase the risk of poor health, (2) the intrinsic overcommitment hypothesis: a high level of overcommitment may increase the risk of poor health, and (3) the interaction hypothesis: employees reporting an extrinsic ERI and a high level of overcommitment have an even higher risk of poor health. The review showed that the extrinsic ERI hypothesis has gained considerable empirical support. Results for overcommitment remain inconsistent and the moderating effect of overcommitment on the relation between ERI and employee health has been scarcely examined. Based on these review results suggestions for future research are proposed.
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Affiliation(s)
- Natasja van Vegchel
- Department of Social and Organizational Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands.
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Desgaste profesional y salud de los profesionales médicos: revisión y propuestas de prevención. Med Clin (Barc) 2004. [DOI: 10.1016/s0025-7753(04)74484-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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van Vegchel N, de Jonge J, Bakker A, Schaufeli W. Testing global and specific indicators of rewards in the Effort-Reward Imbalance Model: Does it make any difference? EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2002. [DOI: 10.1080/13594320244000265] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Prieto Albino L, Robles Agüero E, Salazar Martínez L, Daniel Vega E. [Burnout in primary care doctors of the province of cáceres]. Aten Primaria 2002; 29:294-302. [PMID: 11996730 PMCID: PMC7684242 DOI: 10.1016/s0212-6567(02)70567-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To analyse the degree of professional burnout in primary care doctors from our province and the effect of various factors.Design. Descriptive and analytic cross-sectional study. SETTING Primary care (PC) in the province. PARTICIPANTS All the PC doctors in the province of Cáceres (n=255). MAIN MEASUREMENTS AND RESULTS Self-administered anonymous questionnaire: the Maslach Burnout Inventory that evaluates Depersonalisation (DP), Self-esteem (SE), and Emotional Exhaustion (EE); social and personal variables, work data, personal questions and measures taken if there was work stress. Student s t test, ANOVA (means), and Chi-square or Fisher test (percentages) were used. 157 valid questionnaires were returned (62% response rate). Mean age was 41.5 years old 7.2; 75% were male, 80.2% married, 73.2% had tenure, 48.9% worked in towns, and their mean case-load was 40.5 16.5 patients/day. Mean values found were: DP, 8.3 5.8; SE, 35.2 8.4; EE, 22 11.3; 65.8% scored high on one of the three. For EE mean scores were significantly higher in men, doctors with tenure, in towns, those with >10 years seniority or who saw >40 patients a day. 50% had had psycho-physical disorders in the previous 3 months; 33% withstood a lot of bureaucracy; both groups had <SE and >EE averages. Dedicating <2 hours a day to leisure was associated with >EE; and being a tutor with a significantly higher level of burnout. Disorders in the family or social/work sphere were associated with high levels of DP and EE (P<.001). CONCLUSIONS Like other studies, we found a moderate level of burnout in our sample. Seniority, social/labour or family conflict, and certain personal and job characteristics were associated with high burnout.
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Affiliation(s)
- L. Prieto Albino
- Especialista en Medicina Familiar y Comunitaria. EAP San Jorge. Cáceres
- Doctor en Medicina
- Correspondencia: C/ San Ignacio, 6, 2. A. 10003 Cáceres.
| | - E. Robles Agüero
- Especialista en Medicina Familiar y Comunitaria. EAP San Jorge. Cáceres
| | | | - E. Daniel Vega
- Especialista en Psiquiatría. Servicio de Psiquiatría. H.N. Sra. de la Montaña. Cáceres
- Doctor en Medicina
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Lerman Y, Melamed S, Shragin Y, Kushnir T, Rotgoltz Y, Shirom A, Aronson M. Association between burnout at work and leukocyte adhesiveness/aggregation. Psychosom Med 1999; 61:828-33. [PMID: 10593635 DOI: 10.1097/00006842-199911000-00017] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study examined whether burnout at work is associated with leukocyte adhesiveness/aggregation (LAA), a phenomenon known to be affected by stress. METHODS The LAA levels of 179 employees (68 men and 111 women) of Tel Aviv University were determined when the employees underwent their annual routine medical checkup. Blood pressure and toxic chemical exposure were also measured, and background data were retrieved from medical records. Information on burnout and somatic complaints (known to be a general marker of stress) was collected through a self-report questionnaire. RESULTS Total burnout and each of its subcomponents, emotional exhaustion, chronic fatigue, and cognitive weariness, was significantly associated with LAA levels, even after controlling for age, sex, and educational level. Burnout and somatic complaints intercorrelated positively, but somatic complaints were not significantly associated with LAA levels before or after controlling for the above possible confounders. CONCLUSIONS Burnout was positively associated with LAA levels. This finding is consistent with the growing evidence of the negative impact of burnout on physical health. The lack of an association between somatic complaints and LAA levels reinforces the claim that burnout and stress are two different concepts.
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Affiliation(s)
- Y Lerman
- Occupational Health and Rehabilitation Institute, Ra'annana, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Perski A, Osuchowski K, Andersson L, Sanden A, Feleke E, Anderson G. Intensive rehabilitation of emotionally distressed patients after coronary by-pass grafting. J Intern Med 1999; 246:253-63. [PMID: 10475993 DOI: 10.1046/j.1365-2796.1999.00561.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate whether the status of emotionally distressed post coronary by-pass surgery patients can be improved by a comprehensive, in-patient rehabilitation programme. DESIGN Cross-sectional. SETTING Rehabilitation hospital. SUBJECTS One hundred and fifty-two post coronary by-pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty-three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed. INTERVENTIONS The comprehensive 4-week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling. MAIN OUTCOME MEASURES Physical fitness, blood lipids and quality of life questionnaires. RESULTS The two-way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well-being as assessed by a seven-point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1-year follow-up. CONCLUSIONS Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.
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Affiliation(s)
- A Perski
- Division of Preventive Medicine, Söder Hospital, Karolinska Institute, Stockholm, Sweden.
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Abstract
Psychological factors are known to affect biological processes involved in the progression of coronary artery disease. This article focuses on psychological risk factors for progression of coronary artery disease and its clinical manifestations. Recent research on the adverse cardiovascular consequences of feelings of exhaustion and acute psychological arousal is reviewed, and a classification of psychological risk factors is presented distinguishing (1) chronic psychological risk factors, such as hostility; (2) episodic risk factors, such as exhaustion, with a duration ranging from several months to 2 years; and (3) acute psychological triggers, including mental activity and anger. The distinctive pathophysiological mechanisms by which these psychological risk factors promote coronary disease progression and cardiac ischemia are described, including hemodynamic reactivity, blood clotting, and inflammatory processes.
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Affiliation(s)
- W J Kop
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Melamed S, Ugarten U, Shirom A, Kahana L, Lerman Y, Froom P. Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res 1999; 46:591-8. [PMID: 10454175 DOI: 10.1016/s0022-3999(99)00007-0] [Citation(s) in RCA: 238] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Burnout syndrome, comprised of the symptoms of emotional exhaustion, physical fatigue, and cognitive weariness, is believed to be a result of ineffective coping with enduring stress. This study of 111 nonshift blue-collar workers free of cardiovascular disease (CVD) examined whether chronic burnout is associated with a state of somatic and physiological hyperarousal. Results showed that 37 workers exhibited symptoms of chronic burnout, with symptoms lasting at least 6 months. These workers, compared to those with no burnout symptoms (n = 52) or nonchronic burnout symptoms (n = 22), had higher levels of tension at work, postwork irritability, more sleep disturbances and complaints of waking up exhausted, and higher cortisol levels during the work day. These results suggest that chronic burnout is associated with heightened somatic arousal and elevated salivary cortisol levels. This may be part of the mechanism underlying the emerging association between burnout and risk of CVD.
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Affiliation(s)
- S Melamed
- Occupational Health and Rehabilitation Institute, Raanana, Israel
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Sokejima S, Kagamimori S. Working hours as a risk factor for acute myocardial infarction in Japan: case-control study. BMJ (CLINICAL RESEARCH ED.) 1998; 317:775-80. [PMID: 9740562 PMCID: PMC28666 DOI: 10.1136/bmj.317.7161.775] [Citation(s) in RCA: 206] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To clarify the extent to which working hours affect the risk of acute myocardial infarction, independent of established risk factors and occupational conditions. DESIGN Case-control study. SETTING University and general hospitals and routine medical examinations at workplaces in Japan. SUBJECTS Cases were 195 men aged 30-69 years admitted to hospital with acute myocardial infarction during 1990-3. Controls were 331 men matched at group level for age and occupation who were judged to be free of coronary heart diseases at routine medical examinations in the workplace. MAIN OUTCOME MEASURES Odds ratios for myocardial infarction in relation to previous mean daily working hours in a month and changes in mean working hours during previous year. RESULTS Compared with men with mean working hours of >7-9 hours, the odds ratio of acute myocardial infarction (adjusted for age and occupation) for men with working hours of >11 hours was 2.44 (95% confidence interval 1.26 to 4.73) and for men with working hours of <=7 hours was 3.07 (1.77 to 5.32). Compared with men who experienced an increase of <=1 hour in mean working hours, the adjusted odds ratio of myocardial infarction for men who experienced an increase of >3 hours was 2.53 (1.34 to 4. 77). No appreciable change was observed when odds ratios were adjusted for established and psychosocial risk factors for myocardial infarction. CONCLUSION There was a U shaped relation between the mean working hours and the risk of acute myocardial infarction. There also seemed to be a trend for the risk of infarction to increase with greater increases in mean working hours.
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Affiliation(s)
- S Sokejima
- Department of Welfare Promotion and Epidemiology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama, 930-0194, Japan.
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Abstract
OBJECTIVES To review the literature on burnout and consider its relevance to old age psychiatry and the role of the consultant. DATA SOURCES Medline and PsychLit computerized databases. DATA SYNTHESIS Burnout is a syndrome of emotional exhaustion, depersonalization and decreased sense of personal accomplishment which is recognized in people working in the human service professions and can have adverse effects on the workforce. There is little evidence of unique stressors related to care of elderly mentally ill people. Burnout is likely to be modified by workplace interventions. Relevant areas for intervention are political and social, organizational and management, training and personal issues. Support to consultants and their continuing professional development need to be radically reviewed.
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Affiliation(s)
- S M Benbow
- Carisbrooke Resource Centre, Gorton, Manchester, UK.
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48
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Social support as a buffer in the stress-burnout relationship. INTERNATIONAL JOURNAL OF STRESS MANAGEMENT 1996. [DOI: 10.1007/bf01857718] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Söderfeldt B, Söderfeldt M, Ohlson CG, Warg LE. Psychosomatic symptoms in human service work. A study on Swedish social workers and social insurance personnel. SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE 1996; 24:43-9. [PMID: 8740875 DOI: 10.1177/140349489602400107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study reports on subjective health of personnel in human services and other occupations. A mail questionnaire was sent to 8296 employees in the Social Insurance Organization (SIO) and the Individual and Family Care (IFC) in social welfare agencies. The response rate was 69.1% or 5730 persons. Perceived health was measured by a standard form widely used in occupational health services, FHV004D, here split into four principal components, indicating psycho-vegetative, musculoskeletal, immunological, and gastro-intestinal health. In relation to reference data on other human service personnel (nurses, teachers) and white collar workers (bank and insurance personnel), the studied groups scored much higher on psycho-vegetative symptoms (OR:s about 3), higher on musculo-skeletal symptoms (OR:s about 1.7), but had equal scores on the other symptom types. It is concluded that self-reported psychovegetative and musculoskeletal health is especially problematic in SIO and IFC, indicating stress in human service work. It is hypothesized that an adversary relation to clients can be an aggravating factor in that context.
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Affiliation(s)
- B Söderfeldt
- Department of International Health and Social Medicine, Karolinska Institute, Stockholm, Sweden
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50
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Scheier MF, Bridges MW. Person variables and health: personality predispositions and acute psychological states as shared determinants for disease. Psychosom Med 1995; 57:255-68. [PMID: 7652126 DOI: 10.1097/00006842-199505000-00007] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reviews prospective evidence linking certain classes of person variables to multiple disease end points. Included in the review is a consideration of the effects of hostility and anger, emotional suppression, depression, fatalism, and pessimism on coronary heart disease, cancer, and acquired immunodeficiency syndrome. A model is presented that integrates several of these variables into an overall conceptual scheme. In addition, several variables are identified that appear to moderate the strength of the relationships that are found between person variables and health. The article concludes with some suggested directions for future research.
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Affiliation(s)
- M F Scheier
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15215
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