What is the level of burnout that impairs functioning?

Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory

The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to respond to limitations of current assessments of job-related distress, most notably, assessments relying on the burnout construct. In this study, we conducted a thorough examination of the psychometric and structural properties of the ODI using exploratory structural equation modelling bifactor analysis and Mokken scale analysis. The study involved three samples of employed individuals, recruited in France (N = 3454), Switzerland (N = 1971), and Australia (N = 1485). Results were consistent across the three samples. The ODI exhibited essential unidimensionality and excellent total-score reliability-as indexed by McDonald's omega, Cronbach's alpha, Guttman's lambda-2, and the Molenaar-Sijtsma statistic. We found evidence for measurement invariance across sexes, age groups, and samples. Mokken scale analysis revealed that the ODI's scalability was strong. No monotonicity violation was detected. Invariant item ordering showed sufficient accuracy. In all three samples, suicidal ideation was the least commonly endorsed item-thus acting as a sentinel item-and fatigue/loss of energy was the most commonly endorsed item. The ODI exhibits excellent psychometric and structural properties, suggesting that occupational health specialists can effectively employ the instrument.

Effect of burnout among physicians on observed adverse patient outcomes: a literature review

Background

Physician burnout has potentially harmful effects for both physicians and their patients. Despite relationships between physician burnout and lowered patient satisfaction and clinician-rated adverse patient outcomes, there is scarce literature regarding effects on objective patient outcomes. This study aimed to examine the relationship between physician burnout and observed adverse patient outcomes via a review of the literature.

Methods

A search was performed on the MEDLINE, EMBASE and PsychINFO databases, using keywords and Medical Subject Headings. The identified studies were in English, published from 2007 to 2019, measured burnout among physicians using the Maslach Burnout Inventory (MBI), and included observed adverse patient outcomes. In total, 360 eligible articles were identified, and 11 were included in the final review. All included studies measured patient outcomes by observed clinical measures (e.g. quality of care and medical errors).

Results

Four studies found a clear significant relationship between physician burnout and observed adverse patient outcomes, while 6 did not. One study found a significant relationship with one of the MBI subscales. Burnout was, in contrast to depression, only partly associated with observed patient outcomes.

Conclusions

This review illustrates the need for a validation of physician burnout measured by MBI with respect to observed patient outcomes. Further studies are required to investigate the effects of physician burnout on observed quality of their patient care.

Is Burnout Primarily Linked to Work-Situated Factors? A Relative Weight Analytic Study

It has often been asserted that burnout is primarily linked to occupational-context factors, and only secondarily to individual-level (e.g., personality) and non-work (or general) factors. We evaluated the validity of this view by examining the links between burnout and an array of 22 work-situated (effort-reward imbalance, unreasonable work tasks, unnecessary work tasks, weekly working hours, job autonomy, skill development, performance feedback, and support in work life), work-unrelated (sentimental accomplishment, familial accomplishment, number of child[ren], leisure activities, residential satisfaction, environmental quality, security in daily life, and support in personal life), dispositional (neuroticism, sex, age, and physical condition), and intersecting (work–non-work conflict and non-work–work conflict) variables. The study involved schoolteachers from three different countries: France (N = 4,395), Spain (N = 611), and Switzerland (N = 514). Burnout was assessed with the Maslach Burnout Inventory for Educators. Most of our predictors were assessed based on widely used measures (e.g., neuroticism was assessed with the NEO-Five Factor Inventory). In order to assess sentimental accomplishment and familial accomplishment, we created two self-reported measures, namely, the Sentimental Accomplishment Inventory (SAI; 9 items) and the Familial Accomplishment Inventory (FAI; 9 items). The SAI and the FAI both showed strong reliability and high factorial validity. Exploratory structural equation modeling bifactor analysis and Mokken scaling suggested that both instruments could be considered essentially unidimensional. The study results showed that neuroticism, job strain, skill development, security in daily life, and work–non-work conflict were consistently associated with burnout across the three samples. Sample-specific predictors of burnout included sex, age, unreasonable work tasks, weekly working hours, job autonomy, support in work life, sentimental accomplishment, leisure activities, support in personal life, and non-work–work conflict. Relative weight analysis indicated that neuroticism was the best predictor of burnout in each sample. Our findings suggest that burnout’s nomological network may not be primarily job-related. We conclude that the tendency to de-emphasize individual-level and non-work factors in burnout research is unwise. This tendency may constitute a roadblock in the development of effective interventional strategies. The implications of our findings for burnout’s conceptual status are discussed. The neuroticism-burnout link should be further examined in longitudinal studies.

Burnout is associated with a depressive interpretation style

The aim of this 188-participant study (65% female; mean age = 40.31) was to examine whether burnout and depression are associated with similar interpretation biases in the processing of emotional information. Burnout symptoms were assessed with the Maslach Burnout Inventory-General Survey and depressive symptoms with the 9-item depression module of the Patient Health Questionnaire. Interpretation bias toward emotional information was examined using an amended version of the Word-Sentence Association Paradigm (WSAP). In the WSAP, participants are asked to decide whether emotionally-valenced words are related to ambiguous sentences. Burnout and depression were each associated with a higher endorsement of negative interpretations and a higher ratio of negative interpretations to positive interpretations. Negative word endorsement and positive word endorsement interacted in such a way that negative word endorsement was predictive of burnout and depression only when positive word endorsement levels were relatively low. Our findings suggest that burnout and depression are associated with similar alterations in the interpretation of ambiguous information. This study supports the view that burned out individuals perceive the world with "depressive glasses." Cognitive bias modification techniques employed in the treatment of depressive conditions may constitute relevant therapeutic options for "burned out" individuals.