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Chen YH, Saffari M, Lin CY, Tang HM, Yang CW, Lee CH, Wang WY, Jong GP. Burnout during the COVID-19 pandemic among nurses in Taiwan: the parental role effect on burnout. BMC Health Serv Res 2024; 24:703. [PMID: 38835036 PMCID: PMC11151642 DOI: 10.1186/s12913-024-11159-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, medical workers were concerned about the care of their children or family members and the impact of being separated from them. This increased stress could harm the relationship between nurses and patients. This study assessed how medical workers' parental role may affect burnout during such a high-stress period. METHODS This cross-sectional observational study was carried out in 2021 during the COVID-19 pandemic. The client burnout (CB) scale of the Copenhagen Burnout Inventory, the Nordic Musculoskeletal Questionnaire, and a demographic questionnaire were used. Statistical methods such as the t-test, one-way ANOVA, and univariable/multiple linear regression were applied. RESULTS A total of 612 nurses were included in this study. The likely risk factors of CB were identified and the parenthood effect was found to be associated with reduced CB. The parental role and leisure activity with family and friends on CB were found to have an impact. Engaging in leisure activity with family and playing the role of a parent diligently will help relieve nurses' burnout from frequent contact with patients and their families, thus lowering the risk of clinical burnout. CONCLUSION The parental role, family/friends relationships, and a complex work environment associated with nurses' burnout during the COVID-19 pandemic. This finding allows us to re-examine the importance of family life and parent-child relationships in high-stress work environments.
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Affiliation(s)
- Yong-Hsin Chen
- Department of Public Health, Chung Shan Medical University, Taichung, 402, Taiwan
- Department of Occupational Safety and Health, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan , Taiwan
| | - Hsiu-Mei Tang
- Department of Occupational Safety and Health, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
| | - Ching-Wen Yang
- Department of Occupational Safety and Health, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
| | - Chiu-Hsian Lee
- Department of Nursing, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist, Taichung, 402306, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist, Taichung, 402306, Taiwan
| | - Wei-Yao Wang
- Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist, Taichung, 402306, Taiwan, ROC.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist, Taichung, 402306, Taiwan, ROC.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
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De Beer LT, Schaufeli WB. Casting a Wider Net: On the Utilitarian Nature of Burnout Assessment in the Workplace. Eval Health Prof 2024:1632787241259032. [PMID: 38821879 DOI: 10.1177/01632787241259032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Some consider the burnout label to be controversial, even calling for the abandonment of the term in its entirety. In this communication, we argue for the pragmatic utility of the burnout paradigm from a utilitarian perspective, which advocates the greatest good for the most significant number of employees in organisations. We first distinguish between mild work-related burnout complaints and more severe burnout that can be identified in some contexts. We address the classification of burnout as an 'occupational phenomenon' by the World Health Organization and its ambiguous status in the ICD-11, highlighting the challenge of universally diagnosing burnout as a condition. We argue that a purely clinical approach might be too reactive as it normally only identifies employees with a diagnosable condition. We posit that early detection of burnout through valid assessment can identify struggling employees who do not yet have a diagnosable condition. This proactive approach can help prevent escalation into mental health crises and is more sensible for organisations in terms of effectiveness and employee retention.
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Affiliation(s)
- Leon T De Beer
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- WorkWell Research Unit, North-West University, Potchefstroom, South Africa
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wilmar B Schaufeli
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Research Unit Occupational & Organizational Psychology and Professional Learning, KU Leuven, Leuven, Belgium
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Aronsson I, Neely AS, Boraxbekk CJ, Eskilsson T, Gavelin HM. "Recovery activities are needed every step of the way"-exploring the process of long-term recovery in people previously diagnosed with exhaustion disorder. BMC Psychol 2024; 12:248. [PMID: 38711137 PMCID: PMC11071262 DOI: 10.1186/s40359-024-01756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process. METHOD Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6-10 years after undergoing treatment. The interviews were analyzed with thematic analysis. RESULTS Three themes resulted from the analysis. The first theme, "A long and rocky road", summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants' own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme "Recovery activities are needed every step of the way" describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, "Reorienting to a new place", captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning. CONCLUSIONS Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process. TRIAL REGISTRATION ClinicalTrials.gov: NCT0073772 . Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).
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Affiliation(s)
- Ingela Aronsson
- Department of Psychology, Umeå University, Umeå, 901 87, Sweden.
| | - Anna Stigsdotter Neely
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Carl-Johan Boraxbekk
- Faculty of Medical and Health Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Diagnostics and Intervention, Diagnostic Radiology, and Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Hanna M Gavelin
- Department of Psychology, Umeå University, Umeå, 901 87, Sweden
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
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Kramuschke M, Renner A, Kersting A. [Burnout : Symptoms, diagnostics and treatment approaches]. DER NERVENARZT 2024; 95:484-493. [PMID: 38625570 DOI: 10.1007/s00115-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
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Affiliation(s)
- M Kramuschke
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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van de Leur JC, Johansson F, McCracken LM, Åhs F, Brodda Jansen G, Buhrman M. Mediators during a Multimodal intervention for stress-induced exhaustion disorder. Cogn Behav Ther 2024; 53:235-253. [PMID: 38130175 DOI: 10.1080/16506073.2023.2295217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
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Affiliation(s)
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds University Hospital, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Wallensten J, Ljunggren G, Nager A, Wachtler C, Petrovic P, Carlsson AC. Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression - A cohort study in the total population of Region Stockholm. J Affect Disord 2024; 351:765-773. [PMID: 38331048 DOI: 10.1016/j.jad.2024.01.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ. The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012-2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014-2022. Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5). The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.
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Affiliation(s)
- Johanna Wallensten
- Department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.
| | - Gunnar Ljunggren
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Nager
- Department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Caroline Wachtler
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Predrag Petrovic
- Center for Psychiatry Research (CPF), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Cognitive and Computational Neurosceince (CCNP), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Axel C Carlsson
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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van de Leur JC, Jovicic F, Åhslund A, McCracken LM, Buhrman M. Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. Int J Behav Med 2024; 31:175-191. [PMID: 37308772 PMCID: PMC11001660 DOI: 10.1007/s12529-023-10185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions. METHODS A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL. RESULTS Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation. CONCLUSIONS While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.
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Affiliation(s)
- Jakob Clason van de Leur
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
- PBM Globen Rehab, Arenavägen 27, 121 77, Johanneshov, Sweden.
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Andreas Åhslund
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Lance M McCracken
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
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Verhavert Y, Deliens T, Van Cauwenberg J, Van Hoof E, Matthys C, de Vries J, Clarys P, De Martelaer K, Zinzen E. Associations of lifestyle with burnout risk and recovery need in Flemish secondary schoolteachers: a cross-sectional study. Sci Rep 2024; 14:3268. [PMID: 38332138 PMCID: PMC10853556 DOI: 10.1038/s41598-024-53044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024] Open
Abstract
Teacher burnout and high recovery need are a topic of concern for educational institutions. This cross-sectional study assesses the association between lifestyle (including physical activity (PA), sedentary behavior (SB), dietary behavior and sleep), burnout risk and recovery need in 1878 secondary schoolteachers in Flanders. In September-October 2019, an online-questionnaire assessing burnout (i.e., emotional exhaustion, depersonalization, personal accomplishment), recovery need, PA-domains, SB-domains, dietary behavior (including fruit and vegetable intake and diet quality) and sleep during the week and the weekend was completed. Multiple linear regression models were applied. More emotional exhaustion was associated with more domestic and garden PA, work-related SB and sleep during the weekend, whereas higher scores of emotional exhaustion were associated with lower fruit intake, diet quality and less sleep during the week. More depersonalization was associated with more leisure-time PA and work-related SB and with lower fruit intake. Teachers showing more recovery need, showed more domestic and garden PA and work-related SB, but less leisure-time PA and sleep during the week. Future research should use longitudinal or experimental designs to get more insight into causality. Despite the low effect sizes, education networks and schools might benefit from promoting and facilitating a healthy lifestyle in secondary schoolteachers.
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Affiliation(s)
- Yanni Verhavert
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Tom Deliens
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Jelle Van Cauwenberg
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Research Foundation - Flanders (FWO), Leuvenseweg 38, 1000, Brussels, Belgium
| | | | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Juriena de Vries
- Department of Health, Medical and Neuropyschology, University of Leiden, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Peter Clarys
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Kristine De Martelaer
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Evert Zinzen
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
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Persson R, Österberg K, Björk J. The concurrent validity of the Lund University Checklist for Incipient Exhaustion and the Karolinska Exhaustion Disorder Scale: a replication study. BMC Res Notes 2023; 16:325. [PMID: 37946315 PMCID: PMC10636803 DOI: 10.1186/s13104-023-06589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE As part of our research on Swedish school principals, we examined the concurrent validity between the Karolinska Exhaustion Disorder Scale (KEDS) and the Lund University Checklist for Incipient Exhaustion (LUCIE) in a cross-sectional study sample (N = 2670). Specifically, we examined: (a) to what extent LUCIE and KEDS identified the same individuals and their level of agreement, and (b) to what extent the present observations among school-principals agreed with previous observations made in a highly educated and healthy study sample drawn from the general population. RESULTS Depending on established cut-points on LUCIE, the Kappa agreement (K) between LUCIE and KEDS varied between fair (K = 0.34 [95% Confidence Interval = 0.30-0.38]) and moderate (K = 0.54 [95% Confidence Interval = 0.51-0.58]). While the instruments did not always identify the same individuals, the most reasonable comparison between KEDS and LUCIE was achieved when the cut-off on LUCIE was made between step two and step three. The results essentially replicated our previous results observed in a highly educated and healthy study sample drawn from the general population. The level of agreement suggests that KEDS and LUCIE scores are supplementary rather than interchangeable. Thus, individual result from KEDS and LUCIE are probably best understood in dialogue with the person screened.
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Affiliation(s)
- Roger Persson
- Department of Psychology, Lund University, Lund, SE-22100, Sweden.
| | - Kai Österberg
- Department of Psychology, Lund University, Lund, SE-22100, Sweden
| | - Jonas Björk
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, SE-22100, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, SE-22100, Sweden
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Höglund P, Hakelind C, Nordin M, Nordin S. Risk factors for insomnia and burnout: A longitudinal population-based cohort study. Stress Health 2023; 39:798-812. [PMID: 36634111 DOI: 10.1002/smi.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/13/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023]
Abstract
Insomnia and burnout are highly prevalent in the general population, calling for understanding of its causes. Taking a broad approach, the aim of this study was to determine various mental and somatic risk factors for development of insomnia and burnout and stratifying for sex and age group. Questionnaire data were used from a Swedish population-based sample aged 18-79 years, from which cohorts without insomnia (n = 1702) and without burnout (n = 1972) at baseline were followed-up after 3 years. Self-reports of eight mental and somatic conditions at baseline were used as independent variables in logistic regression analyses to predict development of insomnia and burnout at 3-year follow-up. All eight studied conditions were significant risk factors for development of both insomnia (odds ratio, OR = 1.62-2.73) and burnout (OR = 2.20-3.21). Burnout and poor self-rated health had the highest ORs for insomnia, and poor self-rated health, anxiety and somatic symptoms had the highest ORs for burnout. The ORs were generally similar between men and women, whereas age groups tended to differ in some of the risk factors. The study highlights the importance of a broad assessment of both mental and somatic conditions in the prevention of insomnia and burnout.
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Affiliation(s)
- Per Höglund
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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11
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Gavelin HM, Neely AS, Aronsson I, Josefsson M, Andersson L. Mental fatigue, cognitive performance and autonomic response following sustained mental activity in clinical burnout. Biol Psychol 2023; 183:108661. [PMID: 37598882 DOI: 10.1016/j.biopsycho.2023.108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To investigate the effects of sustained mental activity on perceptions of mental fatigue, cognitive performance, and autonomic response in patients with clinical burnout as compared to a healthy control group. METHODS Patients with clinical burnout (n = 30) and healthy control participants (n = 30) completed a 3-hour test session, in which they were administered a set of cognitive tests before and after an effortful cognitive task with concurrent sound exposure. Perceptions of mental fatigue and task demands (mental effort and concentration difficulties) were assessed repeatedly over the course of the test session. Heart rate variability was recorded to index autonomic response. RESULTS In comparison with controls, perceived mental fatigue increased earlier in the session for the clinical burnout group and did not recover following a short rest period. Throughout the session, patients rated the tasks as more demanding and showed less improvement on measures of attention and processing speed, inhibition and working memory. While autonomic responses were initially comparable, there was a unique decrease in high-frequency heart rate variability in the clinical burnout group after extended testing and exposure. CONCLUSION Patients with clinical burnout are affected differently than healthy controls by sustained mental activity, as reflected by ratings of perceived mental fatigue, aspects of cognitive performance and autonomic response. Further investigation into the role of autonomic regulation in relation to cognitive symptoms in clinical burnout is warranted.
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Affiliation(s)
| | - Anna Stigsdotter Neely
- Department of Social Sciences, Technology and Arts; Department of Health, Education and Technology, Luleå University of Technology, Sweden; Department of Social and Psychological studies, Karlstad University, Sweden
| | | | - Maria Josefsson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Sweden
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Lindsäter E, van de Leur JC, Rück C, Hedman-Lagerlöf E, Bianchi R. Psychometric and structural properties of the Karolinska Exhaustion Disorder Scale: a 1,072-patient study. BMC Psychiatry 2023; 23:642. [PMID: 37660017 PMCID: PMC10475192 DOI: 10.1186/s12888-023-05138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE Exhaustion disorder is a stress-related diagnosis that was introduced in 2005 to the Swedish version of the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). The Karolinska Exhaustion Disorder Scale (KEDS) was developed to assess exhaustion disorder symptomatology. While the KEDS is intended to reflect a single construct and be used based on its total score, the instrument's characteristics have received limited attention. This study investigated the KEDS's psychometric and structural properties in a large clinical sample. METHODS The study relied on data from 1,072 patients diagnosed with exhaustion disorder that were included in two clinical trials in Sweden. We investigated the dimensionality, homogeneity, and reliability of the KEDS using advanced statistical techniques, including exploratory structural equation modeling (ESEM) bifactor analysis. RESULTS A one-factor confirmatory analytic model exhibited a poor fit, suggesting at least a degree of multidimensionality. The ESEM bifactor analysis found the general factor to explain about 72% of the common variance extracted, with an omega hierarchical coefficient of 0.680. Thus, the ESEM bifactor analysis did not clearly support the scale's essential unidimensionality. A homogeneity analysis revealed a scale-level H of only 0.296, suggesting that KEDS's total scores do not accurately rank individuals on the latent continuum assumed to underlie the measure. The KEDS's reliability was modest, signaling considerable measurement error. CONCLUSION Findings reveal important limitations to the KEDS with possible implications for the status of exhaustion disorder as a nosological category. TRIAL REGISTRATION This study was pre-registered on Open Science Framework (osf.io) on April 24, 2022 ( https://osf.io/p34sq/ ).
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Affiliation(s)
- Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet. Gustavsberg Primary Care Clinic, Odelbergs Väg 19, 134 40, Gustavsberg, Sweden.
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden.
| | | | - Christian Rück
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet. Gustavsberg Primary Care Clinic, Odelbergs Väg 19, 134 40, Gustavsberg, Sweden
| | - Renzo Bianchi
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Howe-Heyman A, Harris NR. Systematic Reviews to Inform Practice, September/October 2023. J Midwifery Womens Health 2023; 68:665-674. [PMID: 37679860 DOI: 10.1111/jmwh.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Abby Howe-Heyman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nena R Harris
- Family Nursing, Frontier Nursing University, Fort Mill, South Carolina
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Renaud C, Lacroix A. Neuroticism, perfectionism, and emotion suppression in burnout: Implications for cognitive functioning. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 37572420 DOI: 10.1080/23279095.2023.2244623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
This study aimed to investigate the relationship between burnout and cognitive functions, particularly memory, attention, and executive functions, which have been found to be negatively affected in most studies. However, the results are not consistent across studies, and there is often a discrepancy between self-reported cognitive function and objective assessment. Two possible explanations for this discrepancy are the heterogeneous profiles of individuals in burnout and their personality traits. The study administered neuropsychological tests and questionnaires to 29 participants with clinical burnout to assess their cognitive functions and the impact of perfectionism, neuroticism, and emotion suppression on subjective and objective cognitive scores. The main findings showed little or no deterioration in memory or executive functions, despite patients reporting severely impaired executive function. The study found that neuroticism and perfectionism were related to poorer self-reported executive function, while emotion suppression was related to better self-reported executive function. No relationship was found between personality traits and neuropsychological test scores, indicating a discrepancy between self-perception and objective evaluation.
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Affiliation(s)
- Charlie Renaud
- Laboratoire de Psychologie, Cognition, Comportement, Communication (LP3C), University of Rennes 2, Rennes, Bretagne, France
| | - Agnes Lacroix
- Laboratoire de Psychologie, Cognition, Comportement, Communication (LP3C), University of Rennes 2, Rennes, Bretagne, France
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15
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Franke Föyen L, Sennerstam V, Kontio E, Lekander M, Hedman-Lagerlöf E, Lindsäter E. Objective cognitive functioning in patients with stress-related disorders: a cross-sectional study using remote digital cognitive testing. BMC Psychiatry 2023; 23:565. [PMID: 37550693 PMCID: PMC10405463 DOI: 10.1186/s12888-023-05048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Patients with stress-related mental disorders often report cognitive impairment, but studies investigating objective cognitive impairment in patients with stress-related disorders have produced inconsistent findings. AIM The primary aim of this study was to investigate objective cognitive functioning in patients diagnosed with the stress-related disorders adjustment disorder or exhaustion disorder, compared to a healthy normative group. Secondary aims were to conduct subgroup analyses of cognitive functioning between the diagnostic groups and explore associations between self-reported symptoms and cognitive functioning. METHODS Cognitive test results on a digitally self-administered cognitive test battery from 266 patients (adjustment disorder, n = 131; exhaustion disorder, n = 135) were cross-sectionally compared with results from a healthy normative group (N = 184 to 692) using one-tailed t-tests. ANOVAs were conducted for subgroup analyses, and regression analyses for associations between self-reported symptoms and cognitive functioning. Effect sizes were calculated. RESULTS Patients performed significantly worse than the normative group on all measures with small to moderate effect sizes ranging from d = -.13 to -.57. Those diagnosed with exhaustion disorder performed worse than norms on more measures than did patients with adjustment disorder, but no significant differences between diagnostic groups were found on any measure. Self-reported memory impairment was weakly associated with one of two memory measures. No clear associations between self-reported burnout symptoms and objective cognitive functioning were found. CONCLUSIONS This study adds to the literature indicative of small to moderate objective cognitive impairments in patients diagnosed with stress-related mental disorders. Further exploration into mechanisms of cognitive functioning in different populations is needed for development of theoretical models that may explain the weak correlation between self-reported symptoms and objective measures. TRIAL REGISTRATION ClinicalTrial.gov: NCT04797273. Trial registration date 15 March 2021. This study was also pre-registered on Open Science Framework (osf.io) with https://doi.org/10.17605/OSF.IO/TQXZV .
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Affiliation(s)
- Ludwig Franke Föyen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Victoria Sennerstam
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Evelina Kontio
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
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Steffey MA, Griffon DJ, Risselada M, Scharf VF, Buote NJ, Zamprogno H, Winter AL. Veterinarian burnout demographics and organizational impacts: a narrative review. Front Vet Sci 2023; 10:1184526. [PMID: 37470072 PMCID: PMC10352684 DOI: 10.3389/fvets.2023.1184526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RM, Nieuwenhuijsen K, van der Molen HF. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 2023; 5:CD002892. [PMID: 37169364 PMCID: PMC10175042 DOI: 10.1002/14651858.cd002892.pub6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
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Affiliation(s)
- Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lima M Emal
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Julitta S Boschman
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alice Levasseur
- Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Jani H Ruotsalainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roosmarijn Mc Schelvis
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Body@Work, Research Center on Work, Health and Technology, TNO/VUmc, Amsterdam, Netherlands
| | - Karen Nieuwenhuijsen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Somatic symptoms in burnout in a general adult population. J Psychosom Res 2023; 168:111217. [PMID: 36921422 DOI: 10.1016/j.jpsychores.2023.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Burnout results in individual suffering and high societal costs, and is associated with somatic symptoms, anxiety and depression, calling for prevention by early identification. The objectives were to (i) determine prevalence of specific somatic symptoms in burnout, (ii) identify the symptoms, referred to as somatic symptoms of burnout (SS-B), that are particularly associated with burnout, (iii) determine their extent of association with burnout, and (iv) determine how well a certain number of SS-B differentiates participants with and without burnout in a general Swedish adult population. METHODS Cross-sectional, population-based data were used from 687 participants high on burnout, and 2544 referents based on the Shirom-Melamed Burnout Questionnaire. The Patient Health Questionnaire 15-item Somatic Symptom Severity Scale was used to assess common somatization symptoms, and the Hospital Anxiety and Depression Scale to assess anxiety and depression. RESULTS Feeling tired/having low energy, back pain, joint/limb pain, trouble sleeping, headaches, stomach pain, nausea/gas/indigestion, and constipation/loose bowels/diarrhea were most prevalent in burnout (57.2-95.0%). These symptoms, except for joint/limb pain, and dizziness, were also identified as the SS-B, with odds ratios of 2.34-12.74 and 1.95-9.11 when adjusted for background variables, and for anxiety and depression, respectively. Corresponding odds ratios for each additional number of SS-B were 1.69 and 1.52, respectively. The highest balanced accuracy (71.6%) for predicting burnout was found for ≥4 SS-B. CONCLUSION Fatigue, pain and gastrointestinal symptoms are particularly common in burnout. Further studies may show whether clinicians should consider screening for burnout when patients present with SS-B without pathophysiological explanations.
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De Laet H, Verhavert Y, De Martelaer K, Zinzen E, Deliens T, Van Hoof E. Impact of the COVID-19 pandemic on risk of burn-out syndrome and recovery need among secondary school teachers in Flanders: A prospective study. Front Public Health 2022; 10:1046435. [PMID: 36579060 PMCID: PMC9792144 DOI: 10.3389/fpubh.2022.1046435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
Background Due to the COVID-19 pandemic, schools were closed, teachers had to teach from home and after a while, they had to return to the classroom while the pandemic was still on-going. Even before the pandemic, teachers were already more at risk for burn-out syndrome compared to the general population. Furthermore, not much research pertaining to this population has been carried out during the pandemic and so the impact of the pandemic on teachers' risk of burn-out syndrome and recovery need remains unclear. The aim of the current study was to fill this knowledge gap and map out the impact on risk of burn-out syndrome and recovery need at different time points during the pandemic. Methods and findings At baseline, 2,167 secondary school teachers in Flanders were included in this prospective study. Questionnaire data were obtained at ten different time points between September 2019 and August 2021. To assess risk of burn-out syndrome and its dimensions, the Utrecht Burn-out Scale for Teachers was administered. Need for recovery was assessed using questions adopted from the Short Inventory to Monitor Psychosocial Hazards. The results revealed an initial positive effect of the first lockdown (Mar/Apr 2020) with a decrease in risk of burn-out syndrome [Odds ratio (OR) Jan/Feb 2020-Mar/Apr 2020 = 0.33, p < 0.001], emotional exhaustion (EMM Jan/Feb 2020-Mar/Apr 2020 = -0.51, p < 0.001), depersonalization (EMM Jan/Feb 2020-Mar/Apr 2020 = -0.13, p < 0.001) and recovery need [Estimated marginal mean (EMM) Jan/Feb 2020-Mar/Apr 2020 = -0.79, p < 0.001]. No significant effect on personal accomplishment was found (p = 0.410). However, as the pandemic went on, higher risk of burn-out syndrome, emotional exhaustion, depersonalization and recovery need, and lower personal accomplishment were observed. Conclusions Despite the initial positive impact on risk of burn-out syndrome, its dimensions and recovery need, a negative long-term impact of the COVID-19 pandemic became visible. This study highlights once again the importance for interventions to reduce teachers' risk of burn-out syndrome, especially in such difficult times as a pandemic.
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Affiliation(s)
- Hannah De Laet
- Department of Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yanni Verhavert
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Yanni Verhavert
| | - Kristine De Martelaer
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Evert Zinzen
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Deliens
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elke Van Hoof
- Department of Psychology, Vrije Universiteit Brussel, Brussels, Belgium
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Pischel S, Felfe J, Krick A. Health-oriented leadership: Antecedents of leaders’ awareness regarding warning signals of emerging depression and burnout. GERMAN JOURNAL OF HUMAN RESOURCE MANAGEMENT-ZEITSCHRIFT FUR PERSONALFORSCHUNG 2022. [DOI: 10.1177/23970022221130754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Due to growing demands, there is an increase in depression and burnout causing sickness absence and early retirement. Detecting depression and burnout at an early stage is a crucial task for leaders to allow for early support and prevent more severe illnesses. Within the health-oriented leadership concept, awareness is the ability to recognize followers’ warning signals as a potential health risk. Although it is widely accepted that awareness is a precondition to taking appropriate action, it is yet unclear to what extent leaders recognize the warning signals of followers and which factors facilitate or impede awareness. In an experimental study ( N = 54) and a survey study ( N = 215) we examined antecedents of awareness in followers and leaders: (a) clarity of displayed warning signals in followers, (b) leaders’ stressors, (c) leaders’ autonomy. Even under favorable conditions, only about half of the leaders recognized warning signals as a health risk. Leaders showed lower awareness during times of high stress and low autonomy and when followers displayed less clear warning signals. Autonomy moderated the effect of stress (workload) on awareness, but there was no buffering effect as expected. The findings deepen the theoretical understanding of awareness and suggest that leaders need to know how their awareness may be impeded. We provide practical recommendations for human resource management on how leaders’ awareness can be fostered.
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Affiliation(s)
- Sarah Pischel
- Helmut Schmidt University Hamburg/ University of the Federal Armed Forces, Germany
| | - Jörg Felfe
- Helmut Schmidt University Hamburg/University of the Federal Armed Forces, Germany
| | - Annika Krick
- Helmut Schmidt University Hamburg/University of the Federal Armed Forces, Germany
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Braunheim L, Otten D, Kasinger C, Brähler E, Beutel ME. Individual and Work-Related Predictors of Exhaustion in East and West Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11533. [PMID: 36141803 PMCID: PMC9517610 DOI: 10.3390/ijerph191811533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Chronic exhaustion is a consequence of detrimental working conditions and demands, as well as inadequate coping techniques, potentially resulting in burnout. Previous research has studied occupational environment and individual factors as predictors of exhaustion. Although these differ between former East and West German states, the regional distinction regarding exhaustion has been neglected. To fill this gap, we used the Copenhagen Burnout Inventory in a representative German sample from 2014 to assess the burnout symptom exhaustion. Estimating ordinary least squares regressions, important burnout predictors were compared between the former East and West German states. Regional differences concerning occupational environments were related to the associations between individual factors, situational aspects of technostress and exhaustion. Associations between individual factors (e.g., female sex, lower working hours, age, partnership status, and household income) and exhaustion were stronger in East Germany, whereas technostress (strain of internet use, number of e-mails during leisure time, and social pressure to be constantly available) was more strongly associated with exhaustion in West Germany. Despite lower financial gratification and a higher social pressure to be constantly available in the East, West Germans were more afflicted by exhaustion. Individual factors and technostress should thus be considered when focusing on job-related mental health issues.
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Affiliation(s)
- Lisa Braunheim
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Daniëlle Otten
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweis Str. 10, 04103 Leipzig, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweis Str. 10, 04103 Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweis Str. 10, 04103 Leipzig, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Sowden JF, Schonfeld IS, Bianchi R. Are Australian teachers burned-out or depressed? A confirmatory factor analytic study involving the Occupational Depression Inventory. J Psychosom Res 2022; 157:110783. [PMID: 35325775 DOI: 10.1016/j.jpsychores.2022.110783] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There is mounting evidence that burnout problematically overlaps with depression. However, the generalizability of this finding remains debated. This study examined the burnout-depression distinction based on a recently developed measure of work-attributed depressive symptoms-the Occupational Depression Inventory (ODI). METHODS We relied on a sample of 891 Australian teachers. The ODI was employed to assess work-attributed depressive symptoms. The Shirom-Melamed Burnout Measure (SMBM) and the Oldenburg Burnout Inventory (OLBI) were employed to assess burnout symptoms. The SMBM assesses burnout as a syndrome combining physical fatigue, cognitive weariness, and emotional exhaustion. The OLBI assesses burnout as a syndrome of exhaustion and disengagement. RESULTS Confirmatory factor analysis indicated that the factors underlying burnout's components correlated more highly with the Occupational Depression factor than with each other, calling into question the syndromal unity of burnout. Moreover, the factors underlying burnout's components and the Occupational Depression factor were reflective of a common higher-order factor. CONCLUSIONS Our findings are consistent with the view that burnout symptoms are part of a depressive syndrome and do not reflect a unique or distinct entity. Conducted in the Australian context, this study strengthens the generalizability of the finding that burnout problematically overlaps with depression. Given the profound problems affecting the burnout construct, we recommend a paradigm shift from burnout to occupational depression. Such a shift raises the prospects of more reliably and validly assessing severity and prevalence of job-related distress and, consequently, of reaching more psychologically meaningful and productive conclusions regarding treatment, prevention, and public health decision-making.
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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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Boelhouwer IG, Vermeer W, van Vuuren T. Late Effects of Cancer Treatment, Job Resources, and Burnout Complaints Among Employees With a Breast Cancer Diagnosis 2–10 Years Ago: A Longitudinal Study. Front Psychol 2022; 12:793138. [PMID: 35153917 PMCID: PMC8832114 DOI: 10.3389/fpsyg.2021.793138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to investigate the effect of possible late effects of cancer treatment (physical complaints, fatigue, and cognitive complaints) and of two job resources (autonomy and supportive leadership style) on future burnout complaints, among employees living 2–10 years beyond breast cancer diagnosis. Methods Data at T1 (baseline questionnaire) and at T2 (9 months later) were collected in 2018 and 2019 (N = 287). These data were part of a longitudinal study among Dutch speaking workers with a cancer diagnosis 2–10 years ago. All complaints and job resources were self-reported. Longitudinal multivariate regression analyses were executed, controlling for years since diagnosis, living with cancer (recurrence or metastasis), and other chronic or severe diseases. Mediation by baseline burnout complaints was considered. Results A higher level of fatigue and cognitive complaints at baseline (T1) resulted in higher future burnout complaints (at T2), with partial mediation by baseline burnout complaints. No effect of physical complaints at T1 was observed. Higher levels of autonomy or a supportive leadership style resulted in lower burnout complaints, with full mediation by baseline burnout complaints. Buffering was observed by autonomy in the relationship of cognitive complaints with future burnout complaints. No moderation was observed by supportive leadership. Conclusion The level of burnout complaints among employees 2–10 years beyond breast cancer diagnosis may be an effect of fatigue or cognitive complaints, and awareness of this effect is necessary. Interventions to stimulate supportive leadership and autonomy are advisable, the latter especially in the case of cognitive complaints.
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Affiliation(s)
- Ingrid G. Boelhouwer
- Department of Organisation, Faculty of Management, Open Universiteit, Heerlen, Netherlands
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- *Correspondence: Ingrid G. Boelhouwer,
| | - Willemijn Vermeer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Tinka van Vuuren
- Department of Organisation, Faculty of Management, Open Universiteit, Heerlen, Netherlands
- Loyalis Knowledge & Consult, Heerlen, Netherlands
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Gavelin HM, Domellöf ME, Åström E, Nelson A, Launder NH, Neely AS, Lampit A. Cognitive function in clinical burnout: A systematic review and meta-analysis. WORK AND STRESS 2021. [DOI: 10.1080/02678373.2021.2002972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Andreas Nelson
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Nathalie H. Launder
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
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