Most people do not attribute their burnout symptoms to work

A prevailing belief among researchers is that burnout is a work-specific syndrome induced by intractable job stress. The validity of this belief, however, remains unclear. This cross-sectional study compared burnout with two general conditions, nonspecific psychological distress (NSPD) and exhaustion, in terms of (a) causal attributions to work and (b) associations with 11 job variables (e.g., job satisfaction). The study involved 813 individuals employed in Norway (70.5 % female). Burnout was assessed with the Burnout Assessment Tool; NSPD, with the K6; and exhaustion, with the Karolinska Exhaustion Disorder Scale. Results showed that only 27.7 % of participants with burnout symptoms attributed these symptoms to work. The proportions of individuals ascribing their symptoms to work were similar for NSPD (26.9 %) and exhaustion (27.5 %). The higher one's burnout score, the higher the likelihood of attributing one's burnout, NSPD, and exhaustion symptoms to work. Overall, burnout shared more variance with job variables than did NSPD and exhaustion. Coworker support, job security, and job autonomy constituted notable exceptions. In multiple regression analyses, seven of the 11 job variables predicted NSPD; five predicted burnout and exhaustion. An a posteriori analysis of a nationally balanced quota sample of 591 U.S. employees (48.2 % female) replicated our main finding-only 35.9 % of participants attributed their burnout symptoms to work. This study invites stakeholders to exercise more caution when making etiological inferences about burnout. Assuming that symptoms experienced at work are necessarily caused by work may hinder our ability to mitigate these symptoms. Our findings further question work-centric views of burnout.

Burnout Among Young Adults With Type 1 Diabetes

PURPOSE

The purpose of this qualitative descriptive study was to describe the experience of diabetes burnout in young adults with type 1 diabetes (T1DM). In addition, aims included participant perspectives of risk and protective factors associated with burnout and ways to balance everyday life with diabetes self-management (DSM).

METHODS

Young adults with T1DM (N = 11) were recruited through social media platforms and modified snowball sampling and interviewed. Informational redundancy was achieved. Qualitative thematic coding and analysis were conducted within and across transcripts.

RESULTS

Diabetes burnout was described as the willingness to put diabetes and DSM on the "back burner" and let things slide due to exhaustion, frustration, apathy, and the desire to be like everyone else for a while. Risk and protective factors were identified along with strategies to achieve balance of DSM in everyday life.

CONCLUSIONS

This study identified a clear definition of diabetes burnout and acknowledges this concept as distinct and separate from other psychosocial conditions. Health care providers can utilize this information to identify individuals at risk for diabetes burnout and offer more effective support to lessen the overall burden associated with T1DM.

Burnout and depression: Points of convergence and divergence

BACKGROUND

Debate is ongoing as to whether burnout can be differentiated from depression. This study evaluated whether burnout and depression could be distinguished using a new burnout measure and other variables.

METHODS

Scores on the Sydney Burnout Measure (SBM) were compared between participants with self-diagnosed burnout (BO-all group; n = 622) and clinically-diagnosed depression (DEP-all group; n = 90). The latter group was split into melancholic (DEP-mel; n = 56) and non-melancholic (DEP-nonmel; n = 34) depression subgroups for subsequent analyses. Differences in reporting of depressive symptoms and causal attributions were also evaluated.

RESULTS

While total SBM scores showed poor differentiation, the BO-all group had lower social withdrawal and higher empathy loss subscale scores than the depression groups. Odds ratios were significant for several of the depressive symptoms and causal attribution items when comparing the BO-all group to the DEP-all and DEP-mel groups, while only a few items were significant when comparing the BO-all and DEP-nonmel groups.

LIMITATIONS

Participants in the depression group were assigned by clinician-based depression diagnoses, rather than by a standardised diagnostic interview, and the group had a relatively small sample size. Participants in the burnout group were self-diagnosed and not assessed for comorbid psychiatric diagnoses.

CONCLUSIONS

There were some nuanced symptoms differences between burnout and depression, but many of the SBM symptoms were not specific to burnout. Results also suggested that burnout overlaps more with non-melancholic than melancholic depression, and that differentiation of burnout and depression may rely more on weighting causal factors over symptoms.

The shared and dissociable aspects of burnout, depression, anxiety, and irritability in health professionals during COVID-19 pandemic: A latent and network analysis

Burnout syndrome (BS) has been classified as an independent 'work-related phenomenon', however, there is still an important discussion on whether BS is a unique clinical construct due to the overlapping symptoms with other domains of negative affect such as symptoms of depression, anxiety, and irritability. Thus, we investigated the common and dissociable aspects between BS and domains of negative affect such as depression, anxiety, and irritability through a cross-sectional study with 3428 essential service professionals from a national project during the COVID-19 pandemic. Participants were assessed with Burnout Assessment Tool (BAT) and the Patient-Reported Outcomes Measurement Information System (PROMIS) scales to assess the severity of depression, anxiety, and irritability. The discriminability between the constructs was investigated using correlation tests, Bifactor Exploratory Structural Equation Modeling Bifactor (ESEM), and network analyzes. The mean correlation among the four subscales of BAT-12 was stronger with each other than with depression, anxiety, and irritability. Both ESEM and network analysis, despite showing shared characteristics, clearly delineated that Burnout domains were dissociable from other domains of negative affect. Our findings corroborate the ICD-11 strategy to include BS as a separate entity that cannot be fully explained by variance accounted for by other domains.

Burnout and depression: A cross sectional study among health care workers providing HIV care during the COVID-19 pandemic in Malawi

Health care workers (HCWs) in eastern Africa experience high levels of burnout and depression, and this may be exacerbated during the COVID-19 pandemic due to anxiety and increased work pressure. We assessed the prevalence of burnout, depression and associated factors among Malawian HCWs who provided HIV care during the COVID-19 pandemic. From April-May 2021, between the second and third COVID-19 waves in Malawi, we randomly selected HCWs from 32 purposively selected PEPFAR/USAID-supported health facilities for a cross-sectional survey. We screened for depression using the World Health Organization Self Report Questionnaire (positive screen: score≥8) and for burnout using the Maslach Burnout Inventory tool, (positive screen: moderate-high Emotional Exhaustion and/or moderate-high Depersonalization, and/or low-moderate Personal Accomplishment scores). Logistic regression models were used to evaluate factors associated with depression and burnout. We enrolled 435 HCWs, median age 32 years (IQR 28-38), 54% male, 34% were clinical cadres and 66% lay cadres. Of those surveyed, 28% screened positive for depression, 29% for burnout and 13% for both. In analyses that controlled for age, district, and residence (rural/urban), we found that screening positive for depression was associated with expecting to be infected with COVID-19 in the next 12 months (aOR 2.7, 95%CI 1.3-5.5), and previously having a COVID-19 infection (aOR 2.58, 95CI 1.4-5.0). Screening positive for burnout was associated with being in the clinical cadre (aOR 1.86; 95% CI: 1.2-3.0) and having a positive depression screen (aOR 3.2; 95% CI: 1.9-5.4). Reports of symptoms consistent with burnout and depression were common among Malawian HCWs providing HIV care but prevalence was not higher than in surveys before the COVID-19 pandemic. Regular screening for burnout and depression should be encouraged, given the potential for adverse HCW health outcomes and reduced work performance. Feasible interventions for burnout and depression among HCWs in our setting need to be introduced urgently.

Association of burnout with depression in pharmacists: A network analysis

Background

Burnout and depression have overlapping symptoms, but the extent of overlap remains unclear, and the complex relationship between burnout and depression in pharmacists is rarely explored.

Methods

We investigated burnout and depression in 1,322 frontline pharmacists, and explored the complex relationship between burnout and depression in those pharmacists using network analysis.

Results

Network analysis showed that there were 5 communities. A partial overlap was found between burnout and depressive symptoms in pharmacists. The nodes MBI-6 (I have become more callous toward work since I took this job), D18 (My life is meaningless), and D10 (I get tired for no reason) had the highest expected influence value. D1 (I feel down-hearted and blue) and D14 (I have no hope for the future) were bridge symptoms connected with emotional exhaustion and reduced professional efficacy, respectively.

Conclusion

A partial overlap exists between burnout and depressive symptoms in pharmacists, mainly in the connection between the emotional exhaustion and reduced professional efficacy and the depressive symptoms. Potential core targets identified in this study may inform future prevention and intervention.

Somatic symptoms in burnout in a general adult population

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.

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.

Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance - A General Population Study

Background

We investigated whether stress-related exhaustion (chronic or short-term, and co-occurring with depression or not) is related to cognitive performance and whether polygenic cognitive potential modifies these associations.

Methods

The participants were from the Young Finns Study (N = 541-1273). Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial learning, reaction time, sustained attention, and executive function. Cognitive performance and depression were assessed in 2011, and exhaustion in 2001, 2007, and 2011. A polygenic score for cognitive potential was calculated based on a GWAS on intelligence.

Results

High stress-related exhaustion, especially chronic, was associated with slower reaction time. Only clinical levels of depression were related to slower reaction time. Polygenic cognitive potential did not modify these associations. There were no differences in cognitive performance between individuals with co-occurring exhaustion and depression vs. those with only either condition.

Conclusion

Stress-related exhaustion, especially if chronic, seems to relate to slower reactions. Co-occurring exhaustion and depression may not have additive effects on cognitive performance. High polygenic cognitive potential may not protect from or predispose to harmful effects of exhaustion or depression on reaction time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10354-z.

Relationship between burnout and Major Depressive Disorder in health professionals: A HEAR report

BACKGROUND

Burnout is a "normal" albeit concerning response to workplace stress, whereas Major Depressive Disorder (MDD) is a serious illness associated with impairment and suicide risk. Because of symptomatic overlap between the two conditions and MDD-associated stigma, individuals reporting work-related stress and depression often are "diagnosed" with burnout at the expense of recognizing and treating MDD. Our study aimed to leverage organizational implementation of the American Foundation of Suicide Prevention's Interactive Screening Program to elucidate relationships among burnout, depression, and other suicide risk factors.

METHODS

2281 of about 30,000 (~7.6 %) medical trainees, staff, and faculty responded to an anonymous online stress and depression questionnaire. Respondents were grouped into four cohorts: screened positive for burnout alone (n = 439, 19 %), depression alone (n = 268, 12 %), both conditions (n = 759, 33 %), or neither condition (n = 817, 36 %), and compared on multiple measures of distress and other suicide risk factors.

RESULTS

Burnout alone and depression alone each predicted greater distress and suicide risk compared with neither condition. Depression was a stronger predictor than burnout and demonstrated a consistent association with other suicide risk factors regardless of whether burnout was present. In contrast, burnout was not consistently associated with other suicide risk factors when depression was present.

LIMITATIONS

The sample was limited to one state-supported academic medical center; to individuals who elected to take the online survey; and relied on a single item, non-validated measure of burnout.

CONCLUSION

When emotional distress is reported by healthcare workers, attention should not stop at "burnout," as burnout frequently comingles with clinical depression, a serious and treatable mental health condition.

Stress and Burnout in EFL Teachers: The Mediator Role of Self-Efficacy

Within the class environment, particularly in the language learning setting, stress is considered to be the most common mental condition educators experience in their work, and due to the effect of stress on teachers, burnout similarly occurs because English as a foreign language (EFL) teachers periodically experience affective trauma while participating and engaging in their careers. To solve the problem, one must consider teacher self-efficacy, a significant construct that can mitigate the probability of burnout by preventing the occurrence of stress at work that also plays a key role in enhancing positive upshots. To emphasize the impact of teachers' stress and burnout on the one hand and the mediator role of teachers' efficacy, on the other hand, this mini-review attempted to study the issue. Finally, some scholastic recommendations are pinpointed.

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.

VR Realism Scale-Revalidation of contemporary VR headsets on a Polish sample

This paper presents validation of the VR Simulation Realism Scale on a Polish sample. The scale enables a self-report measurement of perceived realism of a virtual environment in four main aspects of such realism-scene realism, audience behavior realism, audience appearance realism and sound realism. However, since the development of the original scale, the VR technology significantly changed. We aimed to respond to that change and revalidate the original measure in the contemporary setting. For the purpose of scale validation, data was gathered from six studies with 720 participants in total. Five experiments and one online survey were conducted to examine psychometric properties of the scale in accordance with the Standards for Educational and Psychological Testing. Evidence based on internal structure, relations to other variables and test content was obtained. The factorial structure of the original scale was tested and confirmed. The connections between realism and immersion, presence, aesthetics were verified. A suppressed relationship between realism and positive affect was discovered. Moreover, it was confirmed that scale result is dependent on the quality of VR graphics. Results of the analyses provide the evidence that the VR Simulation Realism Scale is a well-established tool that might be used both in science and in VR development. However, further research needs to be done to increase external validity and predictive power of the scale.

The relationship between phubbing and the depression of primary and secondary school teachers: A moderated mediation model of rumination and job burnout

BACKGROUND

With the progress of modern technology and the widespread popularization of mobile phones, many new problems related to mobile phones have aroused people's attention. One of the new phenomena is the phubbing. However, previous studies have paid more attention to the influence of phubbing on the phubbees, few researchers have focused on the influence of phubbing on the phubbers and its influencing mechanism.

METHODS

In the present study, convenient sampling method was adopted, and 907 (432 males, 47.6%) primary and secondary school teachers were recruited from Shanxi province in China. The teachers were all assessed by a series of self-assessment scales, including Generic Scale of Phubbing, the Maslach Burnout Inventory-General Survey, Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale.

RESULTS

The results showed as follows: (1) After controlling for age and gender, phubbing had a significantly positive link to depression of primary and secondary school teachers. Job burnout partially mediated the relation between phubbing and depression. (3) Moderated mediation analysis further indicated that the relation between job burnout and depression were moderated by rumination. Job burnout was a stronger predictor of depression in low ruminants than in high ones.

LIMITATIONS

First, cross-sectional study design was adopted in this study, but it was difficult to infer the causal relationship between variables. Further investigation and verification should be conducted in combination with experiments and follow-up studies, so as to further reveal the mechanism of action between variables. Second, all the data in this study were from the self-report. Although the common method deviation was not obvious, there may be social desirability effect.

CONCLUSIONS

These findings imply that phubbing will not only harm the mental health of the phubbees, but also will affect the mental health of the phubbers. The phubbing enhanced the job burnout of primary and secondary school teachers and increased their risk of depression. Compared with high ruminant, job burnout has a stronger predictive effect on depression in low ruminants. Therefore, we should also pay attention to the mental health problems of phubber teachers in primary and secondary schools.

Mindfulness improves health worker's occupational burnout: the moderating effects of anxiety and depression

OBJECTIVE

This study aims to test whether health workers experiencing both depression, anxiety and burnout would show severer burnout symptoms, and the potential moderating effect of anxiety and depression on mindfulness improving burnout.

METHODS

This study was conducted in a comprehensive hospital of China in 2016. A total of 924 healthcare professionals were included in this cross-sectional study with a response rate of 82.0%. Maslach Burnout Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder, Perceived Stress Scale and Short Inventory of Mindfulness Capability were used to measure burnout, depression, anxiety, perceived stress and mindfulness. Univariate analysis, correlation analysis, mediation analysis and moderated mediation analysis were conducted.

RESULTS

Burnout and anxiety group (BA) and burnout and depression group (BD) reported significantly higher burnout scores compared to the burnout-only group (BO) (59.90 ± 15.700, 56.20 ± 13.190, and 49.99 ± 11.955, respectively). Perceived stress was a mediator between mindfulness and occupational burnout, and depression and anxiety significantly moderated the mediation path between mindfulness and occupational burnout (β for stress in moderated mediation models with depression and anxiety respectively: β = 1.8088, p < 0.001, and β = 1.7908, p < 0.001). For participants who experienced a high level of depression, less occupational burnout was reduced as mindfulness increased. Indirect effect of mindfulness reducing occupational burnout was greater among participants who experienced less anxiety.

CONCLUSIONS

Depression and anxiety weakened the mindfulness ability on relieving occupational burnout, which could be the potential mechanism of the worsening effect of depression and anxiety.

Overlap of burnout-depression symptoms among Chinese neurology graduate students in a national cross-sectional study

BACKGROUND

The overlap of burnout and depression is a phenomenon that can effectively reflect the psychological state of a group. However, whether burnout is a type of depression is still debated in current research. The high incidence of burnout and depressive symptoms among medical students indicates that it is urgent to provide appropriate health services for them. However, the proportion of burnout and depression in the overlapping symptoms experienced by medical students, and the characteristics of the relative influencing factors, remain unclear. Therefore, we addressed these issues for neurology graduate students in China.

METHODS

Using data from a cross-sectional survey of Chinese neurology graduate students, a diagnostic model was established according to their burnout and/or depression symptoms. Burnout was assessed by using the Maslach Burnout Inventory. Depression symptoms were assessed with a two-item depression screening tool for primary care evaluation of mental disorders. Univariate analyses with chi-squared tests were conducted to assess associations between variables. Multinomial logistic regression models were used to analyze the effects of multiple factors on dependent variables. The factors included demographic information and three medical-study related problems.

RESULTS

In total, 32.2% of surveyed students evidenced overlapping burnout and depression symptoms. Students with depressive symptoms tended to be included in the burnout students' category. In the regression model, being unmarried, having children, and career choice regret were related to students who had only burnout, while the students with overlapping symptoms were affected by more factors such as family income, the consideration of dropping out once.

CONCLUSIONS

The symptoms and related factors of burnout and depression among Chinese neurology postgraduates have obvious overlap and show a significant trend. The occurrence of depressive symptoms among medical students is closely related to whether they are burned out. Students with only burnout were common, but students with only depressive symptoms were uncommon. Finally, burnout may be a pre-depression state.

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.

Social Support Mediates the Effect of Burnout on Health in Health Care Professionals

Burnout is characterized by emotional exhaustion and caused by exposure to excessive and prolonged stress related to job conditions. Moreover, burnout is highly prevalent among health care professionals. The aim of this study is, first, to examine the mediating role of social support over the effect of burnout in health care professionals and, second, to explore potential gender differences. A convenience sample of 1,035 health professionals from Ecuador, including 608 physicians and 427 nurses (68% women, with and age M = 40 + 9 years old), was surveyed using the Maslach Burnout Inventory (MBI), Social Support Survey (MOS), and General Health Questionnaire (GHQ-28) as measures of burnout, social support, and general health, respectively. Social support was found to mediate the negative effects of burnout on health regardless of gender. Differences across the three dimensions of burnout and health are further discussed, along with their implications for designing effective burnout interventions for health care professionals in Ecuador.

Associations Between Burnout and Mental Disorder Symptoms Among Nurses in Canada

BACKGROUND

Nurses appear to be at a greater risk of burnout compared to other medical professionals. Higher levels of burnout are significantly associated with higher levels of anxiety, stress, and depression symptoms.

PURPOSE

The current study was designed to estimate levels of burnout among Canadian nurses, examine the association between burnout and mental disorder symptoms, and identify characteristics that may increase the risk for reporting symptoms of burnout.

METHOD

Canadian nurses (n = 3257; 94.3% women) were surveyed online in both English and French. The survey assessed current symptoms of burnout and mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder).

RESULTS

Most nurses (63.2%) reported at least some symptoms of burnout and many (29.3%) reported clinically significant levels of burnout. Age and years of service were the only demographic variables that explained burnout rates. Participants reporting clinically significant levels of burnout were significantly more likely than participants with no burnout to screen positive for all mental disorders, but particularly for Major Depressive Disorder.

CONCLUSIONS

Monitoring burnout may be an effective way to identify nurses at risk of developing symptoms of mental disorders. Younger and early-career nurses are an important group to target for prevention programs.

Burnout and work-related stressors in gastroenterology: a protocol for a multinational observational study in the ASEAN region

BACKGROUND

Clinician burnout is an important occupational hazard that may be exacerbated by the novel COVID-19 pandemic. Within Southeast Asia, burnout in gastroenterology is understudied. The primary objective of this study is to estimate the prevalence of burnout symptoms within gastroenterology, in member states of the Associations of Southeast Asian Nations (ASEAN), during and after the COVID-19 pandemic. The secondary objective is to identify work-related stressors that contribute to burnout in ASEAN gastroenterologists.

METHODS AND ANALYSIS

This is an observational study that will use anonymised online surveys to estimate the prevalence of burnout symptoms at two time points: during the COVID-19 pandemic in 2020 and in 2022 (assumed to be after the pandemic). Gastroenterologists from Singapore, Malaysia, Thailand, Indonesia, Philippines and Brunei will be invited to participate in the online survey through their national gastroenterology and endoscopy societies. Burnout will be assessed using the Maslach Burnout Inventory-Human Services Survey tool. Supplementary questions will collect demographic and qualitative data. Associations between demographic characteristics and burnout will be tested by multiple regression.

RESULTS

The prevalence of burnout symptoms in gastroenterology during the COVID-19 pandemic, and the baseline prevalence after COVID-19, will be established in the above-mentioned countries. Work-related stressors commonly associated with burnout will be identified, allowing the introduction of preventative measures to reduce burnout in the future.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Singhealth Centralised Institutional Review Board (2020/2709). Results will be submitted for publication.

The Occupational Depression Inventory: A new tool for clinicians and epidemiologists

BACKGROUND

Depressive symptoms induced by insurmountable job stress and sick leave for mental health reasons have become a focal concern among occupational health specialists. The present study introduces the Occupational Depression Inventory (ODI), a measure designed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression. The ODI comprises nine symptom items and a subsidiary question assessing turnover intention.

METHODS

A total of 2254 employed individuals were recruited in the U.S., New Zealand, and France. We examined the psychometric and structural properties of the ODI as well as the nomological network of work-attributed depressive symptoms. We adopted an approach centered on exploratory structural equation modeling (ESEM) bifactor analysis. We developed a diagnostic algorithm for identifying likely cases of job-ascribed depression (SPSS syntax provided).

RESULTS

The ODI showed strong reliability and high factorial validity. ESEM bifactor analysis indicated that, as intended, the ODI can be used as a unidimensional measure (Explained Common Variance = 0.891). Work-attributed depressive symptoms correlated in the expected direction with our other variables of interest-e.g., job satisfaction, general health status-and were markedly associated with turnover intention. Of our 2254 participants, 7.6% (n = 172) met the criteria for a provisional diagnosis of job-ascribed depression.

CONCLUSIONS

This study suggests that the ODI constitutes a sound measure of work-attributed depressive symptoms. The ODI may help occupational health researchers and practitioners identify, track, and treat job-ascribed depression more effectively. ODI-based research may contribute to informing occupational health policies and regulations in the future.

Frenetic, under-Challenged, and Worn-out Burnout Subtypes among Brazilian Primary Care Personnel: Validation of the Brazilian "Burnout Clinical Subtype Questionnaire" (BCSQ-36/BCSQ-12)

Primary healthcare personnel show high levels of burnout. A new model of burnout has been developed to distinguish three subtypes: frenetic, under-challenged, and worn-out, which are characterized as overwhelmed, under-stimulated, and disengaged at work, respectively. The aim of this study was to assess the psychometric properties of the long/short Brazilian versions of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-36/BCSQ-12) among Brazilian primary healthcare staff and its possible associations with other psychological health-related outcomes. An online cross-sectional study conducted among 407 Brazilian primary healthcare personnel was developed. Participants answered a Brazil-specific survey including the BCSQ-36/BCSQ-12, "Maslach Burnout Inventory-General Survey", "Utrecht Work Engagement Scale", "Hospital Anxiety/Depression Scale", "Positive-Negative Affect Schedule", and a Visual Analogue Scale of guilt at work. The bifactor was the model with the best fit to the data using the BCSQ-36, which allowed a general factor for each subtype. The three-correlated factors model fit better to the BCSQ-12. Internal consistence was appropriate, and the convergence between the long-short versions was high. The pattern of relationships between the burnout subtypes and the psychological outcomes suggested a progressive deterioration from the frenetic to the under-challenged and worn-out. In sum, the Brazilian BCSQ-36/BCSQ-12 showed appropriate psychometrics to be used in primary healthcare personnel.

A five-sample confirmatory factor analytic study of burnout-depression overlap

OBJECTIVE

It has been asserted that burnout-a condition ascribed to unresolvable job stress-should not be mistaken for a depressive syndrome. In this confirmatory factor analytic study, the validity of this assertion was examined.

METHODS

Five samples of employed individuals, recruited in Switzerland and France, were mobilized for this study (N = 3,113). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, the Maslach Burnout Inventory (MBI)-General Survey, and the MBI for Educators. Depressive symptoms were measured with the PHQ-9.

RESULTS

In all five samples, the latent factors pertaining to burnout's components correlated on average more highly with the latent Depression factor than with each other, even with fatigue-related items removed from the PHQ-9. Second-order factor analyses indicated that the latent Depression factor and the latent factors pertaining to burnout's components were reflective of the same overarching factor.

CONCLUSIONS

This study suggests that the burnout-depression distinction is artificial.

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.

Sex Differences in the Relationship between Student School Burnout and Problematic Internet Use among Adolescents

BACKGROUND

The Internet has many positive sides, but it can also have a negative impact on human emotional-cognitive and behavioral functioning, especially during adolescence. To the most common consequences, the authors add addiction of the teenager to the Internet. This addiction is related to many negative physical and mental problems, including depression, substance abuse and social isolation.

METHODS

In the study, SSBS (Student School Burnout Scale) was used to measure the level of burnout, and the level of Internet addiction was measured using PUI (Internet Addiction Test). The research was carried out among 230 individuals aged 17-20 years.

RESULTS

The results of the research showed that higher level of school burnout is related to higher Internet addiction indicators, and connection was stronger in the male group. Gender significantly predicted Internet addiction and moderated the link between school burnout and Internet addiction. Hierarchical multiple regression analyses confirmed different predictors of Internet addiction for male and female students. However, for both groups, higher burnout due to parents was a significant predictor of Internet addiction (IA).

DISCUSSION

Internet addiction was predicted by school burnout, appearing as a result of parental pressure for high school achievements. In addition, school burnout and school-related characteristics have greater prediction power of Internet addiction and its indicators in a male group.

The benefits of mindfulness-based interventions on burnout among health professionals: A systematic review

OBJECTIVE

Healthcare professional burnout affects performance and has a negative impact on healthcare as a whole. Mindfulness-based Interventions (MIs), developed over the last 30 years, are increasingly used by healthcare professionals to reduce the risk of burnout. Yet the impact of MIs on burnout remains to be clarified. This review aimed to summarize and evaluate the existing literature on the potential benefits of MIs to minimize burnout risk.

METHODS

We conducted a systematic review of the literature, reporting according to the PRISMA standards. PubMed, Psychinfo, Web of Science and Science Direct databases were screened for original articles. Articles in English assessing an MI in combination with burnout measures were included up to September 2018.

RESULTS

Thirty-four articles were included. Only four randomised controlled trials concluded to burnout improvement after several weeks of MIs (11,8%). In the remaining five randomised controlled trials, results did not reach statistical significance. Of the four controlled, non-randomised studies, three showed significant improvements on burnout. Twenty-one studies did not report a controlled trial design. Overall the results appeared to be widely heterogeneous and several methodological concerns arose from the review.

CONCLUSION

This review shows the overall insufficient level of evidence offered by the literature assessing the effects of MIs on burnout in health professional populations. However, some studies have reported promising results and future research should address methodological issues and define more precise contexts of interventions and target populations that could benefit from MIs.

Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease

BACKGROUND

There are forms of Alzheimer's disease (AD) that have an autosomal dominant inheritance pattern; one of them is caused by the E280A mutation in the gene that codes for Presenilin-1 (PSEN1). Studying families of people with this mutation allows the evaluation of characteristics of the subjects before cognitive decline begins.

OBJECTIVE

To determine whether having the mutation E280A in PSEN1 increases the risk of presenting mental disorders in adults under 30 years old who are in the preclinical stage of AD and may be eligible for primary prevention studies of AD.

METHODS

A psychiatric evaluation was made to 120 people belonging to families with a history of early onset AD. Of these, 62 carried the E280A mutation in PSEN1. The occurrence of mental disorders between carriers and non-carriers of the mutation was compared.

RESULTS

No statistically significant differences were found in the frequency of any mental disorder between the group of carriers and non-carriers of the mutation (Hazard Ratio: 0.80, 95% CI 0.49 to 1.31); nor were differences observed when evaluating specific disorders.

CONCLUSION

The E280A mutation does not increase the risk of mental disorders before the age of 30 in the relatives of people affected by familial AD. Studies with larger sample sizes are required to assess the risk of low incidence mental disorders.

WITHDRAWN: Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease

Ahead of Print article withdrawn by publisher.

The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis

Background: Burnout is a psychological syndrome characterized by emotional exhaustion, feelings of cynicism and reduced personal accomplishment. In the past years there has been disagreement on whether burnout and depression are the same or different constructs, as they appear to share some common features (e.g., loss of interest and impaired concentration). However, the results so far are inconclusive and researchers disagree with regard to the degree to which we should expect such overlap. The aim of this systematic review and meta-analysis is to examine the relationship between burnout and depression. Additionally, given that burnout is the result of chronic stress and that working environments can often trigger anxious reactions, we also investigated the relationship between burnout and anxiety. Method: We searched the online databases SCOPUS, Web of Science, MEDLINE (PubMed), and Google Scholar for studies examining the relationship between burnout and depression and burnout and anxiety, which were published between January 2007 and August 2018. Inclusion criteria were used for all studies and included both cross-sectional and longitudinal designs, published and unpublished research articles, full-text articles, articles written in the English language, studies that present the effects sizes of their findings and that used reliable research tools. Results: Our results showed a significant association between burnout and depression (r = 0.520, SE = 0.012, 95% CI = 0.492, 0.547) and burnout and anxiety (r = 0.460, SE = 0.014, 95% CI = 0.421, 0.497). However, moderation analysis for both burnout-depression and burnout-anxiety relationships revealed that the studies in which either the MBI test was used or were rated as having better quality showed lower effect sizes. Conclusions: Our research aims to clarify the relationship between burnout-depression and burnout-anxiety relationships. Our findings revealed no conclusive overlap between burnout and depression and burnout and anxiety, indicating that they are different and robust constructs. Future studies should focus on utilizing more longitudinal designs in order to assess the causal relationships between these variables.

Burnout is more strongly linked to neuroticism than to work-contextualized factors

Burnout has been regarded as a negative affective state resulting from unresolvable job stress. A widespread idea among burnout researchers is that burnout is primarily linked to work-contextualized factors, and only limitedly dependent on general dispositional factors. The validity of this view, however, remains unclear. This 1,759-participant study addressed the issue of whether burnout is more strongly associated with effort-reward imbalance in the job (ERI) and job support than with personality traits neuroticism and extraversion. Burnout was assessed with the Shirom-Melamed Burnout Measure, ERI with the 10-item version of the Effort-Reward Imbalance Questionnaire, job support with the Job Content Questionnaire, and neuroticism and extraversion with the NEO Five-Factor Inventory. Correlation, multiple regression, and relative weight analyses consistently indicated that burnout was primarily linked to neuroticism. Relative weight analysis revealed that the variance in burnout was explained to a much greater extent by neuroticism (53.46%) than by ERI (31.85%) or supervisor and coworker support (5.47% and 2.97%, respectively). Supervisor and coworker support did not explain more variance in burnout than extraversion (6.25%). This study questions the idea that work-contextualized factors outweigh general dispositional factors in burnout. The relevance of personality trait indicators may have been underestimated in burnout research.

Memory bias toward emotional information in burnout and depression

A sample of 1015 educational staff members, exhibiting various levels of burnout and depressive symptoms, underwent a memory test involving incident encoding of positive and negative words and a free recall task. Burnout and depression were each found to be associated with increased recall of negative items and decreased recall of positive items. Results remained statistically significant when controlling for history of depressive disorders. Burnout and depression were not related to mistakes in the reported words, or to the overall number of recalled words. This study suggests that burnout and depression overlap in terms of memory biases toward emotional information.

Burnout, Depression, and Borderline Personality: A 1,163-Participant Study

We examined the association of burnout with borderline personality (BP) traits in a study of 1,163 educational staff (80.9% women; mean age: 42.96). Because burnout has been found to overlap with depression, parallel analyses of burnout and depression were conducted. Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, depressive symptoms with the PHQ-9, and BP traits with the Borderline Personality Questionnaire. Burnout was found to be associated with BP traits, controlling for neuroticism and history of depressive disorders. In women, burnout was linked to both the "affective insecurity" and the "impulsiveness" component of BP. In men, only the link between burnout and "affective insecurity" reached statistical significance. Compared to participants with "low" BP scores, participants with "high" BP scores reported more burnout symptoms, depressive symptoms, neuroticism, and occupational stress and less satisfaction with life. Disattenuated correlations between burnout and depression were close to 1, among both women (0.91) and men (0.94). The patterns of association of burnout and depression with the main study variables were similar, pointing to overlapping nomological networks. Burnout symptoms were only partly attributed to work by our participants. Our findings suggest that burnout is associated with BP traits through burnout-depression overlap.