On the Discriminant Validity of Burnout, Depression and Anxiety: A Re-examination of the Burnout Measure

Prevalence of burnout among military personnel in the plateau region of China: a cross-sectional survey

OBJECTIVES

The geographical environment and military activities in the plateau area pose potential work-related stressors for military personnel, leading to burnout which is an external manifestation of internal energy exhaustion caused by stress. Without countermeasures, this can result in serious military problems. This study aims to examine the association between burnout and occupational stressors among military personnel stationed in the plateau area of China.

MATERIAL AND METHODS

A stratified randomized cluster sampling survey was conducted among 2026 military personnel from 6 different troops stationed in the plateau area of China. The Chinese Maslach Burnout Inventory-General Survey(MBI-GS in Chinese) was administered from March 2022 to December 2023, and data were analyzed using SPSS version 25.

RESULTS

A total of 2026 military personnel participated in the survey. The mean overall burnout score was 3.37 ± 0.73, with emotional exhaustion at 2.69 ± 0.89, depersonalization at 3.58 ± 0.92, and professional achievement at 3.81 ± 0.85 levels respectively reported by participants on average scale scores ranging from zero to six. Severe level of burnout was reported by 43.2% of participants while medium level of burnout was reported by 54 .3%. Age, education level, length of military service, and household income were identified as important factors influencing burnout.

CONCLUSION

This study highlights a relatively high prevalence of burnout among military personnel stationed in plateau areas necessitating attention towards their occupational health particularly focusing on working hours and economic aspects so as to formulate effective policies and implement intervention measures that strengthen career development for soldiers deployed in such regions.

How Does Organizational Toxicity Affect Depression? A Moderated Mediation Model

Organizational toxicity is a key organizational issue today, impacting the success of both employees and organizations negatively alike. Negative working conditions revealed by organizational toxicity pave the way for an organizational atmosphere to arise, which negatively influences the physical and psychological well-being of employees, causing burn-out syndrome and depression. Thus, organizational toxicity is observed to have a destructive impact on employees and can threaten the future of companies. In this framework, this study examines the mediating role of burnout and moderator role of occupational self-efficacy, in the relationship between organizational toxicity and depression. Conducted as cross-sectional, this study adopts a quantitative research approach. To that end, convenience sampling was used to collect data from 727 respondents who are employed at five-star hotels. Data analysis was completed with SPSS 24.0 and AMOS 24 packages. Consequent to the analyses, organizational toxicity was determined to have a positive effect on burnout syndrome and depression. Moreover, burnout syndrome was found to have a mediating effect on the relationship between organizational toxicity and depression. In addition, occupational self-efficacy was found to have a moderator role on the effect of employees' burnout levels on their depression levels. According to the findings, occupational self-efficacy is an influential variable on reducing the impact that organizational toxicity and burnout have on depression.

Teacher burnout and turnover intention in higher education: The mediating role of job satisfaction and the moderating role of proactive personality

Introduction

Teacher burnout and frequent turnover negatively affect stability and productivity in the context of higher education. Despite the fact that the relationship between burnout and turnover intention has been thoroughly studied, the role of other factors in this relationship should be evaluated in order to better clarify underlying mechanisms, particularly in the context of higher education.

Methods

In this study, we first aim to bridge a research gap by utilizing job satisfaction as a mediating variable for the relationship between burnout and turnover intention. Moreover, we uniquely evaluate the role of proactive personality as a moderating variable, first in terms of the relationship between burnout and job satisfaction, and then for the relationship between job satisfaction and turnover intention. Based on 296 valid questionnaires collected from university faculty members in China, proposed hypotheses were evaluated empirically.

Results

The results demonstrate that, as expected, burnout has a significant and positive impact on turnover intention, and job satisfaction has significantly negative impact on turnover intention, with job satisfaction partially mediating the relationship between burnout and turnover intention. Moreover, proactive personality moderated the relationship between job satisfaction and turnover intention, with this relationship being stronger for individuals with high proactive personality as compared to low proactive personality.

Discussion

These findings provide a better understanding of the relationship between burnout and turnover intention of university instructors. Theoretical and practical implications, limitations, and recommendations for further research are provided.

The future of divorce support: Is "digital" enough in presence of conflict?

Divorce conflict is the main driver of adverse postdivorce health adjustments among divorcing families. Despite the growing potential of online divorce support programs, there is concern that such solutions might not be sufficient to impact health-related disparities among high-conflict divorcees. The present study examined the effectiveness of the digital "Cooperation after Divorce" intervention as a function of conflict among 1856 recently divorced Danish residents. Linear mixed-effect regression modeling suggested that, although higher levels of divorce conflict at judicial divorce predicted worse health outcomes up to 1 year following divorce, the effectiveness of the digital divorce intervention did not vary as a function of the initial level of divorce conflict. Individuals in the intervention group with higher conflict in divorce still reported worse health at 12 months follow-up than those with lower levels of divorce conflict; however, much lower than the control group.

Mindfulness and Regulatory Emotional Self-Efficacy of Injured Athletes Returning to Sports: The Mediating Role of Competitive State Anxiety and Athlete Burnout

Usually, both external environmental factors and internal psychological factors affect the self-efficacy of athletes returning to sports after an injury. Based upon COR theory, this study investigated mindfulness interventions' effects on competitive state anxiety and burnout in injured athletes who are returning to sports. The study was conducted in South China from March to April 2022. The snowball and convenience sampling methods were used to select high-level sports teams' injured athletes returning to sports, and a questionnaire survey was administered, from which 433 valid samples were obtained. Amos v. 26 was used to analyze the data. The results showed that mindfulness has a significant negative effect on competitive state anxiety and burnout, such that after strengthening the mindfulness intervention, athletes' competitive state anxiety and burnout decreased and regulatory emotional self-efficacy increased. Further, this study indicated that athletes are prone to negative emotions after injury, and among athletes who returned to sports after injury, those with mindfulness interventions reported lower levels of competitive state anxiety and burnout. Hence, the study demonstrated that mindfulness can improve regulatory emotional self-efficacy in injured athletes who are returning to sports by reducing competitive state anxiety and burnout.

The Mediator Role of Feelings of Guilt in the Process of Burnout and Psychosomatic Disorders: A Cross-Cultural Study

Burnout was recently declared by WHO as an “occupational phenomenon” in the International Classification of Diseases 11th revision (ICD-11), recognizing burnout as a serious health issue. Earlier studies have shown that feelings of guilt appear to be involved in the burnout process. However, the exact nature of the relationships among burnout, guilt and psychosomatic disorders remains unclear. The purpose of this study was to investigate the mediator role of feelings of guilt in the relationship between burnout and psychosomatic disorders, and perform a cross-cultural validation of the multi-dimensional model by Gil-Monte in two samples of teachers (Portuguese vs. Spanish). The study sample was composed of 1,266 teachers, 1,062 from Spain, and 204 from Portugal. Burnout was measured by the Spanish Burnout Inventory. Hypotheses were tested together in a path model. The results obtained provide empirical evidence for the mediator role of guilt in the relationship between the Burnout syndrome and psychosomatic disorders in the sample of teachers from Spain and Portugal, and they contribute to the empirical validation of the model by Gil-Monte. The results indicate that guilt should be incorporated as a symptom of burnout in order to identify individuals affected by burnout and profiles or types of burnout to differentiate it from other pathologies like depression.

How Presenteeism Shaped Teacher Burnout in Cyberbullying Among Students During the COVID-19 Pandemic

The pandemic caused by SARS-CoV2 has had an impact on the education sector, and its stakeholders, such as teachers who had to do remote work from their home, despite many constraints. These professionals tried to perform their teaching functions, despite having to deal with adverse situations, such as cyberbullying among their students, as well as their difficulties related to presenteeism and burnout. In this context, this study aimed to understand whether observing cyberbullying among students can be associated with teachers’ productivity loss due to presenteeism and burnout. This study also proposed to examine the role of productivity loss due to presenteeism in the relationship between observing cyberbullying situations among students and teacher burnout. A random sample of 1,044 (Mage=51.05, SD=7.35; 76.6% female) middle school and high school teachers answered an inventory about their experience working at home during the COVID-19 pandemic, specifically with regards to cyberbullying incidents they observed among their students, their productivity loss due to presenteeism, and their burnout levels. Results from structural equation modeling revealed that observing students engaging in cyberbullying situations was positively associated with productivity loss due to presenteeism and teacher burnout. Also, teacher’s productivity loss due to presenteeism mediated the relationship between observing cyberbullying incidents among their students and their burnout levels. Specifically, the effect of productivity loss due to presenteeism explained the effect of observing cyberbullying incidents on teachers’ burnout levels. These results are innovative and shed light on the importance of teacher wellbeing at their job in the midst of a pandemic, namely, when they observe their students engaging in hostile situations, which may lead them to greater levels of burnout.

The Effect of Primary and Middle School Teachers' Problematic Internet Use and Fear of COVID-19 on Psychological Need Thwarting of Online Teaching and Psychological Distress

Problematic Internet use (PIU) is a risk factor for psychological distress during COVID-19, as teachers are a psychologically vulnerable population. We explored the role of PIU in terms of primary and middle school teachers' fear of COVID-19 and psychological need thwarting (PNT) of online teaching. We empirically evaluated the relationships among these research variables in explaining teachers' psychological distress during COVID-19. Online survey data were collected from 9030 teachers. A high proportion of participants demonstrated psychological distress: depression (20.4%), anxiety (26.4%), and stress (10.2%). Structural equation modeling was used to test our proposed conceptual model, wherein PIU behaviors served as predictors, mediated by fear of COVID-19 and PNT of online teaching, for teachers' psychological distress. With ideal model fit, the results of the path coefficients indicated that PIU behaviors were associated with fear of COVID-19 (p < 0.001); fear of COVID-19 and PNT of online teaching were associated with psychological distress (p < 0.001); and fear of COVID-19 was also positively associated with PNT of online teaching (p < 0.001). PSU and PSMU had an indirect positive effect on psychological distress through the mediator of fear of COVID-19 and PNT of online teaching. As such, we suggest that school administrators pay greater attention to teachers' psychological needs through efforts to enhance teachers' autonomy and relatedness from interpersonal relationships, alleviating PNT of online teaching. Our PNT of online teaching scale may also serve as a contribution for further research and practice.

Slower information processing speed is associated with persistent burnout symptoms but not depression symptoms in nursing workers

Introduction: Burnout and depression both occur with chronic work-related stress, and cognitive deficits have been found when symptom severity results in work disability. Less is known about cognitive deficits associated with milder symptoms among active workers, and few studies have examined whether cognitive deficits predict persistent burnout and depression symptoms. The goal of this study was to examine the association of information processing speed and executive function performance to burnout and depression symptoms at baseline and 12-month follow-up in a sample of actively working individuals (N = 372).Method: The design was prospective with laboratory cognitive data at baseline, and burnout and depressive symptoms assessed at baseline and monthly follow-ups. Information processing speed and executive functions were assessed in a task-switching paradigm, including single-task reaction time (RT), switching costs, and mixing costs. Burnout was assessed with the Exhaustion subscale of the Oldenburg Burnout Inventory and depression with the Patient Health Questionnaire-9.Results: Slower RT was modestly associated with higher levels of burnout symptoms both cross-sectionally and prospectively, but switching costs and mixing costs were not associated with burnout symptoms. None of the cognitive measures were associated with depression symptoms cross-sectionally or prospectively.Conclusions: Despite statistically significant findings of slowed RT in acute exhaustion-related burnout, the proportion of variance accounted for in the models was small and did not predict clinically significant levels of distress. The absence of statistically significant findings for depression symptoms suggests the cognitive profile associated with the exhaustion dimension of burnout may be distinct from that of depression, which reflects a more heterogeneous symptomatology. Our data suggest the clinical impact of burnout symptoms on actively working individuals is marginal; nonetheless, it is important to screen and intervene on burnout and depression symptoms in the workplace because they can lead to other forms of work impairment.

"Divorce burnout" among recently divorced individuals

Traditionally, the concept of burnout has been applied to the workspace but recent research suggests its applicability to more general contexts such as the family sphere. The present study applies burnout to the divorce context and (a) proposes and statistically tests the Divorce Burnout Model (DBM), (b) investigates the contribution of sociodemographic variables and divorce characteristics to burnout scores, and (c) investigates the relationship between burnout scores and the number of sick days and days of absence from work. Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s good fit to data. Using this model, for men, it was found that fewer previous divorces, former spouse initiation of divorce, not having a new partner and a higher degree of conflict significantly predicted higher levels of divorce burnout. For women, lower income, former spouse divorce initiation, not having a new partner, and a higher level of conflict significantly predicted higher levels of divorce burnout. Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms.

The effect of job demands on health and work outcomes: A longitudinal study among Malaysian employees

The purpose of the current study was to investigate the impact of job demands on health and work outcomes among Malaysian workers. We hypothesized that job demands (i.e., emotional demands and physical demands) would predict future work-related burnout and work engagement, in turn affecting sleep problems and job performance (in-role, extra-role). A longitudinal two-wave survey was conducted among Malaysian workers and valid data from 345 participants were analyzed using structural equation modeling. The results revealed that work-related burnout predicts sleep problems while work engagement increased employees' job performance over time. Overall, the current study highlights the importance of specific job demands (i.e., emotional demands and physical demands) that specifically affect health-related behavior and work-related behavior among workers.

Anxiety, depression and associated factors among recently divorced individuals

Background: In divorce research, studies using large samples, very recently divorced individuals and validated measures of depression and anxiety with available background populations for comparison are missing.Aims: This study aimed to investigate symptoms of depression and anxiety among recently divorced Danes and assess the explanatory power of relevant sociodemographic- and divorce-related variables on these symptoms.Methods: The study utilized an online cross-sectional design and a total of 1856 Danish citizens recruited through the Danish State Administration. Average scores for depression and anxiety were compared to the Danish background population and regression analyses were conducted to assess the explanatory power of sociodemographic- and divorce characteristics on symptoms of depression and anxiety.Results: Divorcees reported significantly higher levels of both depressive and anxiety symptoms than the background population with a large proportion of the sample scoring equal to or higher than generally recommended cut-off values for risk of suffering from a psychiatric diagnosable case of depression or anxiety. Both sociodemographic- and divorce characteristics were predictive of symptoms of depression and anxiety.Conclusion: The findings underline the relevance of public health intervention targeting symptoms of depression and anxiety among recently divorced individuals.

Burnout and its relationship with work-related factors among occupational therapists working in public sector in Turkey

BACKGROUND

Burnout is an important and challenging issue in occupational therapists as in other health care professions.

AIMS/OBJECTIVES

The study aimed to identify burnout and its relationship with job satisfaction, work engagement and working conditions among occupational therapists in Turkey.

MATERIAL AND METHODS

The study included 50 occupational therapists working in public sector. The Burnout Measure, the Minnesota Job Satisfaction Questionnaire, and the Utrecht Work Engagement Scale were used as measurement tools. Working conditions were measured by a questionnaire specifically designed for this study.

RESULTS

The findings indicated that 26% of the participants had burnout symptoms and 38% were at risk. Negative relationships were found between burnout and working conditions, extrinsic and overall job satisfaction, vigour and dedication. Working conditions and dedication were the most influential factors of burnout among these variables and together accounted for 43.1% of the variance. A moderate negative relationship was found between burnout and two items of working conditions (facilitative management structure and opportunities to improve skills) and those together predicted 39% of the variance for burnout.

CONCLUSIONS AND SIGNIFICANCE

Identifying work-related factors that may affect burnout, including working conditions, job satisfaction, and work engagement, and developing intervention strategies are important for occupational therapists.

The role of psychological detachment in burnout and depression: A longitudinal study of Malaysian workers

The current study aimed to examine the role of psychological detachment in the relationship between working conditions and burnout and depression. First, the study proposed that job demands would increase burnout after four months but not depression. Second, it proposed that psychological detachment would moderate the impact of job demands and job resources on burnout and depression. Third, it was proposed that the interaction between job demands, job resources and psychological detachment would predict burnout and depression. The longitudinal study design involved 345 workers (at both Time 1 and Time 2). The hierarchical regression analysis showed that increasing psychological detachment reduced the negative relationship between physical demands and depression four months later. In contrast, high psychological detachment increased the negative association between emotional resources and burnout, but not between emotional resources and depression. Overall, this study, in its discovery of the impact of working conditions on psychological health, has made a new contribution to psychological detachment studies by using different sub-constructs of job demands and job resources (i.e., emotional and physical) with four-month gaps, as previous studies did not address the impact within this time frame.

Moral Distress and Considering Leaving in NICU Nurses: Direct Effects and Indirect Effects Mediated by Burnout and the Hospital Ethical Climate

BACKGROUND

Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses.

OBJECTIVES

The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses.

METHODS

This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3-4 NICUs in New South Wales, Australia.

RESULTS

Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (p = 0.651). Burnout (odds ratio [OR] 4.25, p < 0.001) and the hospital ethical climate (OR = 0.29, p = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (B = 0.32, 95% confidence interval [CI] [0.147-0.611]) and the hospital ethical climate (B = 0.19, 95% CI [0.085-0.382]) were significant.

CONCLUSIONS

The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.

Burnout in Nurses Working With Youth With Chronic Pain: A Pilot Intervention

Objective

Nurse burnout is a significant issue, with repercussions for the nurse, patients, and health-care system. Our prior mixed-methods analyses helped inform a model of burnout in nurses working with youth with chronic pain. Our aims were to (a) detail the development of an intervention to decrease burnout; (b) evaluate the intervention's feasibility and acceptability; and (c) provide preliminary outcomes on the intervention.

Method

In total, 33 nurses working on a pediatric inpatient care unit that admits patients with chronic pain conditions participated in the single-session 90-min groups (eight to nine nurses per group). The intervention consisted of four modules including (1) helping patients view pain as multifaceted and shift attention to functioning; (2) teaching problem-solving and reflective listening skills; (3) highlighting positives about patients when venting with coworkers; and (4) improving nurses own self-care practices. Measures provided assessment of feasibility, acceptability, and effectiveness at baseline and 3 months postintervention in a single group, repeated measures design.

Results

Data support the feasibility and acceptability of the intervention. Pilot outcome results demonstrated improvements in the target behaviors of education on psychosocial influences, self-care, and venting to coworkers as well as self-compassion, general health, and burnout. There were no changes in pain beliefs or the target behaviors of focus on functioning, empathizing with patient, or highlighting positives.

Conclusions

Our single-session tailored group treatment was feasible and acceptable, and pilot data suggest that it is beneficial, but a more comprehensive approach is encouraged to reduce burnout that might be related to multiple individual, unit, and system factors.

The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities

PURPOSE

The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students' intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation.

METHOD

The authors used repeated-measures data from a longitudinal study of 3,756 students at 49 U.S. medical schools that were collected from 2010 to 2014. They conducted generalized linear mixed models to estimate whether manifestations of racism in school curricula/policies, school culture/climate, or student attitudes/behaviors predicted first- to fourth-year changes in students' intentions to practice in underserved communities or primarily with minority populations. Analyses were stratified by students' practice intentions (no/undecided/yes) at matriculation.

RESULTS

Students' more negative explicit racial attitudes were associated with decreased intention to practice with underserved or minority populations at graduation. Service learning experiences and a curriculum focused on improving minority health were associated with increased intention to practice in underserved communities. A curriculum focused on minority health/disparities, students' perceived skill at developing relationships with minority patients, the proportion of minority students at the school, and the perception of a tense interracial environment were all associated with increased intention to care for minority patients.

CONCLUSIONS

This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students' decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI_asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI_asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

Work Values of Police Officers and Their Relationship With Job Burnout and Work Engagement

Values represent people's highest priorities and are cognitive representations of basic motivations. Work values determine what is important for employees in their work and what they want to achieve in their work. Past research shows that levels of both aspects of job-related well-being, job burnout and work engagement, are related to work values. The policing profession is associated with high engagement and a risk of burnout. There is a gap in the literature regarding the hierarchy of work values in police officers, how work values are associated with job burnout and work engagement in this group, and whether work values in police officers are sensitive to different levels of job burnout and work engagement. Therefore, the aim of our study was to examine the relationships between work values and job burnout and work engagement, in a group of experienced police officers. We investigated: (a) the hierarchy of work values based on Super's theory of career development, (b) relationships between work values and burnout and work engagement, and (c) differences between the work values in four groups (burned-out, strained, engaged, and relaxed). A group of 234 Polish police officers completed the Work Values Inventory (WVI) modeled upon Super's theory, the Oldenburg Burnout Inventory and the Utrecht Work Engagement Scale. The results show that police officers gave the highest priority to extrinsic work values. Job burnout was negatively correlated with the cognitive intrinsic work values (Creativity, Challenge, and Variety), while work engagement was positively correlated with the largest group of intrinsic work values (Creativity, Challenge, Variety, Altruism, and Achievement), as well as with the extrinsic work values (Prestige and Co-workers). The police officers showed significant differences, between levels of job burnout and work engagement, for intrinsic work values such as Variety, Challenge, and Creativity (large effects), and for Altruism and Prestige (moderate effects). The findings are discussed within the context of the Conservation of Resources theory, which explains how people invest and protect their personal resources, and how this is connected with preferred work values. We conclude that intrinsic work values are sensitive to different levels of burnout and engagement.

MECHANISMS IN ENDOCRINOLOGY: Endocrine and immunological aspects of burnout: a narrative review

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.

Moderating Effect of Mindfulness on the Relationships Between Perceived Stress and Mental Health Outcomes Among Chinese Intensive Care Nurses

This study aimed to explore the potential moderating effect of mindfulness and its facets on the relationships among perceived stress and mental health outcomes (burnout, depression, anxiety, and subjective well-being) among Chinese intensive care nurses. A total of 500 Chinese intensive care nurses completed self-report measures of mindfulness, burnout syndromes, perceived stress, depression, anxiety, and subjective well-being. Correlation and hierarchical multiple regressions were applied for data analysis. Mindfulness moderated the effects of perceived stress on emotional exhaustion (the core component of burnout syndrome), depression, anxiety, positive affect, and negative affect but not on the other two dimensions of burnout and life satisfaction. Further analyses indicated that the ability to act with awareness was particularly crucial in improving the effects of perceived stress on depression. These results further broaden our understanding of the relationships between perceived stress and burnout, depression, anxiety, and subjective well-being by demonstrating that mindfulness may serve as a protective factor that alleviates or eliminates the negative effects of perceived stress on depression, anxiety, burnout syndrome, and subjective well-being and may instigate further research into targeted mindfulness interventions for Chinese intensive care nurses.

The Implications of Psychological Symptoms for Length of Sick Leave

BACKGROUND

In this cross-sectional study, we aimed to determine the relation between sick leave duration, burnout symptoms, depression, anxiety, and somatization in a primary care setting.

METHODS

Patients receiving a sickness certificate in one of 14 participating primary care practices were consecutively asked by their primary care physician to fill in a questionnaire comprising the Maslach Burnout Inventory-General Survey (MBI-GS) and the Patient Health Questionnaire (PHQ) containing the depression (PHQ-9), somatization (PHQ-15), and anxiety (GAD-7) scales. The main diagnosis on the sickness certificate was documented by the issuing physician. A quasi-Poisson regression analysis was performed to estimate the influence of burnout symptoms, depression, and anxiety on length of sick leave.

RESULTS

225 patients participated, 122 (54.2%) were female; the mean age was 39.5 years. Length of sick leave correlated with emotional exhaustion (p = 0.005), depersonalization (p = 0.013), depression (p = 0.006), anxiety (p = 0.023), and somatization (p = 0.001). However, regression analysis revealed that the only predictors for length of sick leave were anxiety (exp[0.081] = 1.084; p = 0.013), age (exp[0.017] = 1.017; p = 0.041) and education (exp[- 0.508] = 0.602; p = 0:029). The pseudo R2 of the model was 0.25.

CONCLUSION

The impact of anxiety on burnout symptoms and sick leave days might have been underestimated so far. A holistic approach in patient centered communication should comprise the evaluation of psychosomatic comorbidity under consideration of the established concepts of depression and anxiety disorder to ensure adequate diagnostic and therapeutic management.

The effects of psychological maladjustments on predicting developmental trajectories of academic burnout

We identified developmental trajectories of academic burnout related to psychological maladjustments (i.e., compulsion and depression) in 7th and 8th grade Korean adolescents.

This is vital because it facilitates early awareness of burnout trends and related psychological maladjustments, which might influence mental health problems, thus promoting proactive prevention and intervention before deterioration. We utilized four-wave longitudinal data from 415 adolescents who completed the Maslach Burnout Inventory-Student Survey and Symptom Check List-47. Data were analysed using growth mixture modeling. The results indicated that developmental trajectories of academic burnout can be characterized by three linear trajectories, ‘moderate-maintain’ ( N = 213, 51.33%) which is related to depression, ‘low-deteriorated’ ( N = 15, 3.61%) which is related to compulsion, and ‘well-adjusted’ ( N = 158, 38.07%) which is related to no maladjustment symptoms. This longitudinal study promotes understanding of middle school students who may experience academic burnout and can facilitate early interventions for academic burnout.

Transformational leadership and autonomy support management behaviors

Purpose

The purpose of this paper is to investigate the relationships between transformational leadership (TL), autonomy support management behaviors and employees’ psychological health.

Design/methodology/approach

A total of 512 Canadian workers assessed their immediate supervisor’s level of TL and autonomy support management behaviors. Participants also assessed their own psychological health through measures of psychological well-being and burnout at work.

Findings

Results from structural equation modeling indicate that TL is related to employee psychological well-being and burnout. This effect is fully mediated by more specific autonomy support and psychological control management behaviors. These results suggest that autonomy support and psychological control management behaviors may have a more proximal effect on employees’ psychological health than TL does. Also, managers’ leadership and behaviors appear to better predict employees’ psychological well-being at work than employee burnout.

Practical implications

Managers with a TL style employ more autonomy support and fewer psychological control behaviors, which makes employees happier and less burned out. Based on these results, leadership training programs would gain to focus on the development of more specific management behaviors among leaders, such as autonomy support, to enhance employees’ psychological health, especially their well-being.

Originality/value

This research expands understanding of the relationship between TL and the psychological health of employees by shedding light on the mediating role of autonomy support management behaviors in this relationship.

An Underlying Common Factor, Influenced by Genetics and Unique Environment, Explains the Covariation Between Major Depressive Disorder, Generalized Anxiety Disorder, and Burnout: A Swedish Twin Study

Depression and anxiety are highly comorbid due to shared genetic risk factors, but less is known about whether burnout shares these risk factors. We aimed to examine whether the covariation between major depressive disorder (MDD), generalized anxiety disorder (GAD), and burnout is explained by common genetic and/or environmental factors. This cross-sectional study included 25,378 Swedish twins responding to a survey in 2005-2006. Structural equation models were used to analyze whether the trait variances and covariances were due to additive genetics, non-additive genetics, shared environment, and unique environment. Univariate analyses tested sex limitation models and multivariate analysis tested Cholesky, independent pathway, and common pathway models. The phenotypic correlations were 0.71 (0.69-0.74) between MDD and GAD, 0.58 (0.56-0.60) between MDD and burnout, and 0.53 (0.50-0.56) between GAD and burnout. Heritabilities were 45% for MDD, 49% for GAD, and 38% for burnout; no statistically significant sex differences were found. A common pathway model was chosen as the final model. The common factor was influenced by genetics (58%) and unique environment (42%), and explained 77% of the variation in MDD, 69% in GAD, and 44% in burnout. GAD and burnout had additive genetic factors unique to the phenotypes (11% each), while MDD did not. Unique environment explained 23% of the variability in MDD, 20% in GAD, and 45% in burnout. In conclusion, the covariation was explained by an underlying common factor, largely influenced by genetics. Burnout was to a large degree influenced by unique environmental factors not shared with MDD and GAD.

Applying the demand-control-support model on burnout in managers and non-managers

Purpose

– The purpose of this paper is to study the demand-control-support (DCS) model on burnout in male and female managers and non-managers, taking into account genetic and shared family environmental factors, contributing to the understanding of mechanisms of how and when work stress is related to burnout.

Design/methodology/approach

– A total of 5,510 individuals in complete same-sex twin pairs from the Swedish Twin Registry were included in the analyses. Co-twin control analyses were performed using linear mixed modeling, comparing between-pairs and within-pair effects, stratified by zygosity and sex.

Findings

– Managers scored higher on demands and control in their work than non-managers, and female managers seem to be particularly at risk for burnout facing more demands which are not reduced by a higher control as in their male counterparts. Co-twin analyses showed that associations between control and burnout as well as between demands and burnout seem to be affected by shared family environmental factors in male non-managers but not in male managers in which instead the associations between social support and burnout seem to be influenced by shared family environment.

Practical implications

– Taken together, the study offers knowledge that shared environment as well as sex and managerial status are important factors to consider in how DCS is associated to exhaustion.

Originality/value

– Using twin data with possibilities to control for genetics, shared environment, sex and age, this study offers unique insight into the DCS research, which focusses primarily on the workplace environment rather than individual factors.

Burnout and Depression: Two Entities or One?

OBJECTIVES

The purpose of this study was to examine the overlap in burnout and depression.

METHOD

The sample comprised 1,386 schoolteachers (mean [M]age = 43; Myears taught = 15; 77% women) from 18 different U.S. states. We assessed burnout, using the Shirom-Melamed Burnout Measure, and depression, using the depression module of the Patient Health Questionnaire.

RESULTS

Treated dimensionally, burnout and depressive symptoms were strongly correlated (.77; disattenuated correlation, .84). Burnout and depressive symptoms were similarly correlated with each of 3 stress-related factors, stressful life events, job adversity, and workplace support. In categorical analyses, 86% of the teachers identified as burned out met criteria for a provisional diagnosis of depression. Exploratory analyses revealed a link between burnout and anxiety.

CONCLUSIONS

This study provides evidence that past research has underestimated burnout-depression overlap. The state of burnout is likely to be a form of depression. Given the magnitude of burnout-depression overlap, treatments for depression may help workers identified as "burned out."

Differentiating Burnout from Depression: Personality Matters!

Stress-related affective disorders have been identified as a core health problem of the twenty-first century. In the endeavor to identify vulnerability factors, personality has been discussed as a major factor explaining and predicting disorders like depression or burnout. An unsolved question is whether there are specific personality factors allowing differentiation of burnout from depression. The present study tested the relation between one of the most prominent, biological personality theories, Cloninger's Temperament and Character Inventory, and common measures of burnout (Maslach Burnout Inventory General) and depression (Beck Depression Inventory 2) in a sample of German employees (N = 944) and a sample of inpatients (N = 425). Although the same personality traits (harm avoidance and self-directedness) were predominantly associated with burnout and depression, there was a much stronger association to depression than to burnout in both samples. Besides, we observed specific associations between personality traits and subcomponents of burnout. Our results underline differences in the association of burnout vs. depression to personality, which may mirror differences in scope. While symptoms of depression affect all aspects of life, burnout is supposed to be specifically related to the workplace and its requirements. The much stronger association of personality to depression can be important to select appropriate therapy methods and to develop a more specified treatment for burnout in comparison to depression.

Burnout-depression overlap: a review

Whether burnout is a form of depression or a distinct phenomenon is an object of controversy. The aim of the present article was to provide an up-to-date review of the literature dedicated to the question of burnout-depression overlap. A systematic literature search was carried out in PubMed, PsycINFO, and IngentaConnect. A total of 92 studies were identified as informing the issue of burnout-depression overlap. The current state of the art suggests that the distinction between burnout and depression is conceptually fragile. It is notably unclear how the state of burnout (i.e., the end stage of the burnout process) is conceived to differ from clinical depression. Empirically, evidence for the distinctiveness of the burnout phenomenon has been inconsistent, with the most recent studies casting doubt on that distinctiveness. The absence of consensual diagnostic criteria for burnout and burnout research's insufficient consideration of the heterogeneity of depressive disorders constitute major obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the seminal, field-dominating definition of burnout is questioned. It is suggested that systematic clinical observation should be given a central place in future research on burnout-depression overlap.

The covariation between burnout and sick leave due to mental disorders is explained by a shared genetic liability: a prospective swedish twin study with a five-year follow-up

BACKGROUND

This study aims to assess whether the associations between burnout and sick leave due to stress-related mental disorders, other mental disorders, and somatic conditions are influenced by familial (genetic and shared environmental) factors.

METHODS

In this prospective cohort study, 23,611 Swedish twins born between 1959 and 1985, who answered a web-based questionnaire, including the Pines Burnout Measure 2004-2006, were included. Registry data on sick leave spells from the response date until December 31, 2010 were obtained from the Swedish Social Insurance Agency. Logistic regression analysis was performed to assess odds ratios with 95% confidence intervals for the association between burnout and sick leave for the whole sample, while conditional logistic regression of the same-sex discordant twin pairs was used to estimate the association between burnout and sick leave, adjusting for familial confounding. The Bivariate Cholesky models were used to assess whether the covariation between burnout and sick leave was explained by common genetic and/or shared environmental factors.

RESULTS

Burnout was a risk factor for sick leave due to stress-related and other mental disorders, and these associations were explained by familial factors. The phenotypic correlation between burnout and sick leave due to somatic conditions was 0.07 and the association was not influenced by familial factors. The phenotypic correlations between burnout and sick leave due to stress-related (0.26) and other mental disorders (0.30) were completely explained by common genetic factors.

CONCLUSIONS

The association between burnout and sick leave due to stress-related and other mental disorders seems to be a reflection of a shared genetic liability.

Burnout, vigour, big five personality traits and social support in a sample of police officers

Orientation: Burnout occurs as a result of prolonged job stress, which is a phenomenon prevalent amongst police officers in South Africa. Whilst some suffer from burnout, others elude the pathological effects of burnout and execute their duties vigorously under the same circumstances.Research purpose: The purpose of the study was to obtain an understanding of a police officer’s need to reduce the effects of prolonged stressors and to utilise personal and social sources to mitigate the effects of negative stressors.Motivation for the study: Burnout causes negative health consequences for police officers. Those who are affected reflect withdrawal behaviour through operational disruption or lower productivity in the work context. Research design, approach and method: The research has a non-experimental design in the quantitative tradition with a cross-sectional data-collection method. The availability sample (N = 505) included participants from different demographic backgrounds. A survey was used to measure all constructs at a single point in time.Main findings: Neuroticism and a lack of family support predicted burnout whilst conscientiousness and emotional stability predicted vigour. This was followed by significant other, which predicted physical strength, friend support which predicted emotional energy and family support which predicted cognitive liveliness.Practical/managerial implications: The study provides markers for selection purposes and calls on police management to be aware of the value of social support in the prevention of burnout whilst encouraging supervisor support in operational designs.Contribution/value-add: The study adds to the body of knowledge on the role of personality and social support in burnout and vigour in police officers.

The importance of genetic and shared environmental factors for the associations between job demands, control, support and burnout

Within occupational health research, one of the most influential models is the Job Demands-Control-Support model. Numerous studies have applied the model to different domains, with both physical and psychological health outcomes, such as burnout. The twin design provides a unique and powerful research methodology for examining the effects of environmental risk factors on burnout while taking familial factors (genetic and shared environment) into account. The aim of the present study was to investigate the impact of familial factors on the associations of burnout with job demands, control and support. A total of 14 516 individuals from the Swedish Twin Registry, who were born between 1959 and 1986, and who participated in the Study of Twin Adults: Genes and Environment (STAGE) by responding to a web-based questionnaire in 2005, were included in the analyses. Of these, there were 5108 individuals in complete same-sex twin pairs. Co-twin control analyses were performed using linear mixed modeling, comparing between-pairs effects and within-pair effects, stratified also by zygosity and sex. The results indicate that familial factors are of importance in the association between support and burnout in both women and men, but not between job demands and burnout. There are also tendencies towards familial factors being involved in the association between control and burnout in men. These results offer increased understanding of the mechanisms involved in the associations between work stress and burnout.

Inmates-to-staff assaults, PTSD and burnout: profiles of risk and vulnerability

Prison employees are often confronted with critical incidents and chronic stressors that may lead to trauma or burnout symptoms. However, most of the research on clinical aspects of interpersonal violence in prisons (inmates-to-staff violence, specifically) focuses either on trauma or on burnout. The purpose of the present study is (a) to examine both burnout and posttraumatic stress among prison staff and (b) to examine the influences of inmates-to-staff violent relations on posttraumatic stress in terms of risk profile to develop PTSD. A random sample of French correctional employees has completed various self-reported questionnaires assessing burnout, posttraumatic stress, and stress as well as victimization and demographic characteristics. Correctional employees demonstrated high levels of PTSD symptoms, burnout, and stress. Violent interactions with inmates lead to experienced trauma of all types (PTSD, secondary, or vicarious trauma). Results have highlighted a prison worker's profile prone to PTSD: he or she expresses high levels of emotional exhaustion, intense levels of stress, high levels of depersonalization, and high levels of intrusion, avoidance, and hyperreactivity. This study contributes to an understanding of the literature by explaining the complex association between burnout and posttraumatic stress after interpersonal violence. These findings suggest a need to support prison workers and to address inmates-to-staff relational dynamics.

Defining the student burnout construct: a structural analysis from three burnout inventories

College student burnout has been assessed mainly with the Maslach burnout inventory (MBI). However, the construct's definition and measurement with MBI has drawn several criticisms and new inventories have been suggested for the evaluation of the syndrome. A redefinition of the construct of student burnout is proposed by means of a structural equation model, reflecting burnout as a second order factor defined by factors from the MBI-student survey (MBI-SS); the Copenhagen burnout inventory-student survey (CBI-SS) and the Oldenburg burnout inventory-student survey (OLBI-SS). Standardized regression weights from Burnout to Exhaustion and Cynicism from the MBI-SS scale, personal burnout and studies related burnout from the CBI, and exhaustion and disengagement from OLBI, show that these factors are strong manifestations of students' burnout. For college students, the burnout construct is best defined by two dimensions described as "physical and psychological exhaustion" and "cynicism and disengagement".

Do burnout and work engagement predict depressive symptoms and life satisfaction? A three-wave seven-year prospective study

BACKGROUND

Burnout and work engagement have been viewed as opposite, yet distinct states of employee well-being. We investigated whether work-related indicators of well-being (i.e. burnout and work engagement) spill-over and generalize to context-free well-being (i.e. depressive symptoms and life satisfaction). More specifically, we examined the causal direction: does burnout/work engagement lead to depressive symptoms/life satisfaction, or the other way around?

METHODS

Three surveys were conducted. In 2003, 71% of all Finnish dentists were surveyed (n=3255), and the response rate of the 3-year follow-up was 84% (n=2555). The second follow-up was conducted four years later with a response rate of 86% (n=1964). Structural equation modeling was used to investigate the cross-lagged associations between the study variables across time.

RESULTS

Burnout predicted depressive symptoms and life dissatisfaction from T1 to T2 and from T2 to T3. Conversely, work engagement had a negative effect on depressive symptoms and a positive effect on life satisfaction, both from T1 to T2 and from T2 to T3, even after adjusting for the impact of burnout at every occasion.

LIMITATIONS

The study was conducted among one occupational group, which limits its generalizability.

CONCLUSIONS

Work-related well-being predicts general wellbeing in the long-term. For example, burnout predicts depressive symptoms and not vice versa. In addition, burnout and work engagement are not direct opposites. Instead, both have unique, incremental impacts on life satisfaction and depressive symptoms.

Psychometric properties of the "Spanish Burnout Inventory" in Chilean professionals working to physical disabled people

While the most commonly employed burnout measure has been the Maslach Burnout Inventory (MBI), researchers have been troubled by some of the psychometric limitations of this instrument. The aim of this study was to analyze the psychometric properties of the "Spanish Burnout Inventory" (SBI). The psychometric properties were analysed with data from a sample of 277 Chilean professionals working to physical disabled people. The psychometric properties of the SBI were examined through the following analyses: confirmatory factor analysis, reliability Cronbach's alpha, and concurrent validity with the MBI. The hypothesized four factor model obtained an adequate data fit for the sample (chi2(164) = 285.32, p < .001, GFI = .96, RMSEA = .052, NNFI .93, CFI = .94). Results confirmed the hypothesis formulated. The Cronbach's alpha coefficient was higher than .70 for the four scales of the instruments. Results supported the concurrent validity with the MBI. As a whole, the results of these study provided evidence on the adequate psychometric properties of the SBI for the study of burnout in the Chilean cultural context.

Work-Related Negative Experience

This cross-sectional study examines the relationship between poor employee well-being (PEWB) and work-related mental ill-health and substance consumption (MIH). It is proposed as a unification model that links both work-related negative consequences on the basis of the experiences of threat, loss, and frustration at work. PEWB contains the following elements: emotional discomfort, bodily uneasiness, organizational distance, task impairment, and dragging workday; and MIH includes work-related anxiety, depression, irritability, cigarette smoking, alcohol and drug consumption, and physical illness. Six hundred ninety-seven participants, working in a wide range of jobs and occupations, completed the survey. Results indicated that PEWB and MIH are significantly associated, after controlling for demographic and personal factors. Sense sharing between PEWB-MIH and PEWB element combination explained the relationships between both constructs. These findings could be helpful for organizations interested in preserving and improving worker mental health.

Age and distress of women--results of a representative population-based study

Little research has been carried out on prevalence rates of distress (e.g. depression, posttraumatic stress symptoms (PTSS), hopelessness, and burnout) of women in different age groups. The aims of this study were to measure the prevalence rate of depression, posttraumatic stress symptoms, hopelessness, and burnout among women and to clarify the associations between age groups and distress. Cross sectional epidemiological study on women in Sweden (n = 6,000, aged 18-64 years, response rate 64.1%). Measures were questionnaires on socio-economic and work-related characteristics and on depression, posttraumatic stress symptoms, hopelessness, and burnout. Depression was measured with the "General Health Questionnaire" (GHQ), PTSS with the "Posttraumatic Symptom Scale", hopelessness with the "Hopelessness Scale" and burnout with the "Shiron-Melamed Burnout Questionnaire" (SMBQ). The prevalence rate of depression varied from 12.5% to 14.1%; of posttraumatic stress symptoms from 23.5% to 33.3%; of hopelessness from 11.5% to 16%; and of burnout from 22.9% to 17.1%. Depression was not associated with age group. Hopelessness was associated with age group in univariate analysis bur not in multivariate analysis (OR = 0.7, 95% CI = 0.5-1.0). PTSS and burnout were associated with age group. Both symptoms were higher in the youngest age group, compared to the eldest age group (posttraumatic stress symptoms: OR = 1.6, 95% CI = 1.2, 2.1; burnout: OR = 1.5, 95% CI = 1.1-2.1). Younger women show higher prevalence rates of PTSS and burnout compared to elder women. The higher prevalence rates of PTSS and burnout among younger women may be associated with job strain and/or with violent life events.

Depression and the metabolic syndrome: gender-dependent associations

This study was designed to test the extent to which depressive symptoms are associated with the presence of the metabolic syndrome (MS) and each of its components, and whether these relationships are gender dependent. Participants were apparently healthy employed men (N=2,355) and women (N=1,525) who underwent a routine health check between the years 2003 and 2005. We used logistic regression analysis, predicting the MS by depressive symptoms, as assessed by the Patient Health Questionnaire, and the following control variables: age, education, smoking status, physical exercise, anxiety, and burnout. As hypothesized, we found that depression among women, but not men, was associated with a 1.94-fold risk of having the MS, and with an elevated risk of having two of its five components: elevated waist circumference (odds ratio, OR=2.23) and elevated glucose levels (OR=2.44). In addition, a positive trend was observed toward an association with the other three components: low high-density lipoprotein, hypertension, and elevated triglycerides. Among men depression was associated with elevated waist circumference only (OR=1.77). These findings suggest that especially among women, the association between depression and cardiovascular diseases might be linked to metabolic processes. If replicated in longitudinal studies, these findings may have important health-care policy implications with regard to depression management interventions.