Cognitive functioning in relation to burnout symptoms and social and occupational functioning in a population-based sample of young adults

Unified and distinct cognitive control deficits in adolescents with cognitive disengagement syndrome and learning burnout

Introduction

Cognitive disengagement syndrome (CDS) is a psychological disorder characterized by daydreaming, mental fogginess, and slow thinking, while learning burnout (LB) is characterized by a passive and inattentive attitude toward learning. These two disorders are closely related but can be challenging to differentiate from one another. The present study aimed to identify shared and distinct cognitive control deficits between CDS and LB.

Methods

We recruited 136 adolescents (aged 14 to 17 years) from an initial screening of CDS and LB (N = 476) and divided them into four groups: CDS, LB, CDS + LB, and typically developing control. After a second screening, 129 adolescents completed two tasks to assess their attentional networks and cognitive control capacity (CCC).

Results

Adolescents with high CDS symptoms (both CDS group and CDS+LB group) exhibited impaired disengaging effect of attention and lower CCC, indicating deficits in orienting attention and the upper limit of information processing for cognitive control specifically. Furthermore, support vector machine modeling identified CCC as the most significant parameter differentiating the CDS and LB groups.

Discussion

Our findings suggest that while adolescents with high CDS and high LB symptoms have similar outward manifestations in the adolescent's school life, deficits in attention and cognitive control, particularly in the CCC, may distinguish between the two groups.

Attention Deficits in Healthcare Workers with Non-Clinical Burnout: An Exploratory Investigation

Burnout syndrome is characterized by exhaustion, cynicism, and reduced effectiveness. Workers with high burnout scores who continue their professional activities are identified as experiencing non-clinical burnout (NCB), which includes early stages where burnout symptoms (BNS) are present but not yet severe enough to necessitate work leave. This study aimed to investigate the impact of BNS on attention performance among healthcare workers (HCWs) at a COVID-19 reference hospital during the pandemic. The Maslach Burnout Inventory (MBI) was applied to assess the three burnout dimensions. The Continuous Visual Attention Test (CVAT) evaluated four different attention subdomains. Participants were divided into two groups based on their scores on the MBI: controls and NCB. Thirteen controls were matched with 13 NCB subjects based on age, sex, and HCW category. This sample (n = 26, 65% male) consisted of 11 physicians and 15 nursing professionals with a mean age of 35.3 years (standard deviation = 5.47). NCB subjects had higher impulsivity than controls. There were not any significant group differences in the other attention subdomains. We found significant correlations between impulsivity and all burnout dimensions: higher absolute scores in BNS are associated with higher impulsivity. We concluded that NCB leads to executive attention deficits.

Neuroticism, perfectionism, and emotion suppression in burnout: Implications for cognitive functioning

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.

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.

Cognitive functioning in non-clinical burnout: Using cognitive tasks to disentangle the relationship in a three-wave longitudinal study

Burnout is often characterized by cognitive deficits and it has been associated with depression and anxiety. However, it is not clear whether cognitive impairment is a burnout consequence or employees with poor cognitive skills are more prone in developing burnout. Moreover, the exact nature of the association between burnout and depression, and burnout and anxiety is still unknown. Depression and anxiety are also related to cognitive impairments but their prospective associations are not fully understood. The aim of the present three-wave longitudinal study was to investigate the causality between cognitive functioning, burnout, depression, and anxiety among non-clinical burnout employees. The cause-effect associations of burnout with depression and anxiety were also explored. Perceived family support as a protective factor against cognitive decline, burnout, depression and anxiety was examined as well. A wide range of cognitive tasks tapping different cognitive domains were administered to employees of the general working population. Burnout, depression, anxiety, and perceived family support were assessed with self-reported questionnaires. Present results suggest that visuospatial functioning deficits are a burnout consequence and they indicate the role of automatic processing skills and executive functions in burnout onset. Additionally, current findings support that burnout is differentiated from depression and anxiety but it is reciprocally associated with the two psychological phenomena. Lastly, current results support the inclusion of perceived family support as an intervention to help individuals who suffer from mental health and cognitive difficulties.

Chronic stress and executive functioning: A specification-curve analysis

To investigate the association between chronic stress and executive functioning (EF), we assessed 514 young to middle-aged adults in three EF tasks (i.e., Number-Letter, 2-Back, Go/Nogo) that assessed shifting, updating, and inhibition. Chronic stress was assessed by various self-report measures and hair cortisol concentrations as indicators of subjective and objective chronic stress, respectively. In order to test the association between chronic stress and EF, we fit a structural equation model with a latent common EF factor predicted by subjective and objective chronic stress on Kaplan-Meier estimates of response times. Controlling for participants' sex, age household income and the delay between cognitive testing and hair sample collection, neither subjective nor objective chronic stress showed a meaningful association with common EF. Exploratory analyses suggested a moderation effect of income on the association between subjective chronic stress and common EF, with a smaller association for high-income participants. Additionally, we conducted a specification-curve analysis on the association between chronic stress and EF to assess the influence of different analysis choices on results in our dataset. This analysis confirmed the absence of a coherent association between chronic stress and EF by showing that the majority of analytical choices produced null effects and only a small number of analytical choices produced meaningful associations (negative or positive). Taken together, our findings suggest that common EF likely remains preserved under the influence of chronic stress. Our specification-curve analysis, however, also shows that chronic stress may also have either a positive or a negative effect on EF, depending on the choice of covariates and measures of chronic stress and EF. Consequently, more research on the role of these factors for the association between chronic stress and EF is needed to avoid the interpretation of non-replicable stress-EF associations caused by analytical choices or selection bias.

Organizational Justice and Cognitive Failures in Japanese Employees: A Cross-Sectional Study

OBJECTIVE

We examined the association of organizational justice (ie, procedural justice and interactional justice) with cognitive failures, and the mediation effect of psychological distress on this association in Japanese employees.

METHODS

A total of 189 men and 35 women from two sites of a manufacturing company in Japan were surveyed using a self-administered web-based questionnaire. A multiple mediation analysis was conducted.

RESULTS

A significant negative total effect of procedural justice on cognitive failures was observed (c = -0.180 [95% confidence interval: -0.315 to -0.044]). Furthermore, the mediation effect of psychological distress was significant (c-c' = -0.213 [95% confidence interval: -0.323 to -0.115]). Similar patterns were observed for interactional justice.

CONCLUSIONS

Employees may be more likely to experience cognitive failures in daily activities in work settings where organizational justice is lower, which seems to be explained by psychological distress.

Impaired cognitive functioning in stress-induced exhaustion disorder: a new tablet-based assessment

BACKGROUND

The adverse health effects of stress induced exhaustion disorder (SED) cause increasing concern in Western societies. This disorder is characterized by severe fatigue, decreased tolerance to further stress, and attention and memory lapses. Despite subjective complaints, individual cognitive deficits are not always detected in a clinical setting, which calls for the validation of more sensitive instruments.

AIM

The objective of this study was to investigate if a short, tablet-based serial naming task, MapCog Spectra (MCS) could be used as a marker for cognitive problems in SED.

PARTICIPANTS

The study comprised of 39 subjects (35 females, four males) with SED. Their mean age was 46,8 years (SD 10.1; range 30-60 yrs.). All participants were healthcare professionals, with a college or university degree, doctors, registered nurses, and psychologists.

METHODS

The MCS was used to assess the number of aberrant pauses during serial naming of coloured geometrical shapes. The Coding, Matrix Reasoning, Digit Span, Symbol Search of the WAIS-IV, and RUFF 2&7 tests, were administered together with a short interview.

RESULTS

Mean values were within normal reference limits for all tests, except for the MCS, which showed a significantly higher number of aberrant pauses (p < 0,001) in the SED group, compared to normal reference values. Although subjects performed within normal limits on the RUFF 2&7, a significant difference between individuals was found in the performance strategy of the participants.

CONCLUSION

Here we report that subjects with SED have performance deficits on the MCS, in terms of aberrant pause times, despite average performance on WAIS-IV tests measuring inductive reasoning, processing speed, working memory, and attention. We also demonstrate that subjects use different strategies to overcome their problems. These findings add to the growing evidence of cognitive deficits in SED and that the MCS might aid neuropsychologists in disentangling cognitive markers, important to substantiate the subjective complaints of affected individuals.

Auditory deviance detection and involuntary attention allocation in occupational burnout-A follow-up study

Here, we investigated the central auditory processing and attentional control associated with both recovery and prolongation of occupational burnout. We recorded the event-related brain potentials N1, P2, mismatch negativity (MMN) and P3a to nine changes in speech sounds and to three rarely presented emotional (happy, angry and sad) utterances from individuals with burnout (N = 16) and their matched controls (N = 12). After the 5 years follow-up, one control had acquired burnout, half (N = 8) of the burnout group had recovered, and the other half (prolonged burnout) still had burnout. The processing of acoustical changes in speech sounds was mainly intact. Prolongation of the burnout was associated with a decrease in MMN amplitude and an increase in P3a amplitude for the happy stimulus. The results suggest that, in the absence of interventions, burnout is a persistent condition, associated with alterations of attentional control, that may be amplified with the prolongation of the condition.

Burnout and Cognitive Performance

The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout–cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout–cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.

Self-reported cognitive difficulties and cognitive functioning in relation to emotional exhaustion: Evidence from two studies

Individuals with burnout often report having difficulties with concentration and memory in everyday life. However, empirical evidence on cognitive decline using performance-based measures is limited and often obtained on small clinical samples. The aim of the present two studies was to investigate cognitive correlates of emotional exhaustion on otherwise healthy populations at different life stages with varying degrees of burnout. A total of 201 graduate and undergraduate students participated in Study 1, and a heterogeneous sample (N = 203) of working individuals took part in Study 2. Cognitive performance was assessed by self-reported cognitive difficulties and three performance-based cognitive tests of sustained attention, inhibition of irrelevant information, and inhibition of prepotent responses. Controlling for gender, age, and depression symptoms, multiple regression analyses in Study 1 indicated a positive relationship between emotional exhaustion and self-reported cognitive difficulties but no correlation with the performance-based cognitive measures. A similar pattern of results emerged in Study 2. However, we found tentative evidence for cognitive impairment on the sustained attention measure. The results of these two studies partially support previous findings and extend the literature on cognitive aspects of burnout.

Cognitive functioning, sleep quality, and work performance in non-clinical burnout: The role of working memory

We investigated the relationship between cognitive functioning, work performance, and sleep in non-clinical burnout. In a working population, an online survey was conducted with additional online neuropsychological tests of varying complexity, measuring attention and different components of working memory, of which the coordinating subcomponent the ‘Central Executive’ is thought to be the most vulnerable to stress. Results indicate that non-clinical burnout is associated with more—though not severe—sleep problems, more depressive complaints, impaired work performance, and with both subjective and objective cognitive impairments. Compared with healthy respondents (N = 107), people with non-clinical burnout (N = 17) had a significantly poorer performance on the tests of the visuospatial sketchpad and the Central Executive of the working memory. Our study also indicates that more complex tests may be more sensitive in detecting cognitive dysfunction in non-clinical burnout. Furthermore, a relationship was found between dual-task performance and work performance. Regarding to sleep quality, in our sample of people with non-clinical burnout, there were no severe sleep problems. In the entire sample, however, insomnia was significantly related to subjective, but not objective, cognitive functioning, and also not to work performance.

Thinking Against Burnout? An Individual's Tendency to Engage in and Enjoy Thinking as a Potential Resilience Factor of Burnout Symptoms and Burnout-Related Impairment in Executive Functioning

The personality trait need for cognition (NFC) refers to individual differences in the tendency to engage in and enjoy cognitive endeavors. In today's working world, which is characterized by increasing cognitive demands, NFC may contribute to resilience against work-related stress and burnout symptoms. We investigated this question in a large population-wide sample of 4,134 individuals (Study 1) and in a sample of 125 students (Study 2). NFC was consistently negatively related to the burnout facets emotional exhaustion and reduced personal efficacy of the Maslach burnout inventory and explained up to 10% additional variance in burnout symptoms over and above the five-factor model of personality. In the student sample, where stress factors are mainly cognitive in nature, NFC was the most relevant predictor. In this sample, we additionally investigated whether NFC might be a relevant moderator of the inconsistently found associations between burnout and impairments in cognitive functioning. The participants conducted three cognitive tasks (number-letter task, two-back task, and Go/NoGo task) that measure the executive functions switching, updating, and response inhibition, respectively. While burnout was slightly negatively related to working memory performance, NFC did not moderate the relationship between burnout and executive control which could be traced back to the young and healthy sample used to examine this research question. All in all, our results clearly suggest that NFC may be an important individual difference factor contributing to the resilience against burnout, especially if stress factors are cognitive in nature.

Reduced self-regulation mirrors the distorting effects of burnout symptomatology on task difficulty perception during an inhibition task

Burnout, a pathological consequence of chronic work stress, shows an increasing incidence rate in industrialized countries. Previous findings indicate that burnout may be linked to a detachment of the negative association between subjectively appraised task demand and cognitive performance, which is typically seen in healthy individuals. The present study sought to confirm this relationship and to investigate whether this dissociation is mirrored in a biological marker of self-regulation, i.e., resting vagally mediated heart rate variability (HRV). A heterogeneous sample (N = 65) of working adults (M age = 43.3, SD = 10; 23.1 % male) with varying degrees of burnout symptomatology completed three cognitive tasks (2-back, number-letter, and go/nogo) to assess different domains of executive functioning (updating, set-shifting, and inhibition), and respective demand ratings. Additionally, vagally mediated HRV at rest, operationalized as the root-mean square differences of successive R-R intervals (RMSSD), was recorded. Burnout symptomatology moderated the association between subjective task difficulty and performance parameters of the go/nogo task, such that higher burnout scores were associated with reductions in the naturally occurring negative association between self-rated task demand and response inhibition. Intriguingly, this pattern was mirrored when replacing burnout with HRV. These findings suggest that burnout symptomatology, and individual differences in self-regulatory capacities (indexed by resting HRV), may alter one's capacity for accurate task evaluation, a mechanism which could potentially underlie the dissociation between self-rated cognitive function and actual performance among individuals experiencing burnout.

The relationship between sluggish cognitive tempo and burnout symptoms in psychiatrists with different therapeutic approaches

Burnout is a serious problem for psychiatrists that has implications for clinical practice and personal health. While burnout is known to affect cognitive functions, no studies have examined the relationship between sluggish cognitive tempo (SCT) and burnout. This study aimed to examine this relationship and related factors as socio-demographic, occupational environment in psychiatrists. Participants(n=201, aged between 25 and 52 years,57.7% female) completed socio-demographic information form, Maslach Burnout Inventory and SCT Scale. According to our results, we have shown that total burnout scores and emotional exhaustion (EE) scores were significantly higher in psychiatrists with SCT. SCT scores were positively correlated with mean total burnout, EE, and depersonalization scores. We did not find any differences between subgroups according to departments, therapeutic approaches and gender. In conclusion, we want to highlight that psychiatrists with SCT were more proneness to general burnout symptoms and were more emotionally exhausted regardless of their therapeutic approach or their profession as adult or child/adolescent psychiatrists.

Cognitive Impairments in Occupational Burnout - Error Processing and Its Indices of Reactive and Proactive Control

The presented study refers to cognitive aspects of burnout as the effects of long-term work-related stress. The purpose of the study was to investigate electrophysiological correlates of burnout to explain the mechanisms of the core burnout symptoms: exhaustion and depersonalization/cynicism. The analyzed error-related electrophysiological markers shed light on impaired cognitive mechanisms and the specific changes in information-processing in burnout. In the EEG study design (N = 80), two components of error-related potential (ERP), error-related negativity (ERN), and error positivity (Pe), were analyzed. In the non-clinical burnout group (N = 40), a significant increase in ERN amplitude and a decrease in Pe amplitude were observed compared to controls (N = 40). Enhanced error detection, indexed by increased ERN amplitude, and diminished response monitoring, indexed by decreased Pe amplitude, reveal emerging cognitive problems in the non-clinical burnout group. Cognitive impairments in burnout subjects relate to both reactive and unconscious (ERN) and proactive and conscious (Pe) aspects of error processing. The results indicate a stronger ‘reactive control mode’ that can deplete resources for proactive control and the ability to actively maintain goals. The analysis refers to error processing and specific task demands, thus should not be extended to cognitive processes in general. The characteristics of ERP patterns in burnout resemble psychophysiological indexes of anxiety (increased ERN) and depressive symptoms (decreased Pe), showing to some extent an overlapping effect of burnout and related symptoms and disorders. The results support the scarce existing data on the psychobiological nature of burnout, while extending and specifying its cognitive characteristics.

[Cognitive impairments accompanying the burnout syndrome - a review]

BACKGROUND

The rising prevalence of the burnout syndrome has increasingly moved it into the focus of scientific interest. In addition to emotional exhaustion and depersonalization, particularly reduced personal accomplishment has strong societal and economic effects. In recent years reduced personal accomplishment has increasingly been linked to cognitive impairment. However, up to now only a few studies have objectively assessed cognitive deficits in burnout patients. This article gives an overview of 16 studies which examined cognitive abilities in burnout patients. The findings are partly contradictory, probably due to methodical differences. Consensus has emerged concerning impairments of executive functions, i.a. vigilance, and memory updating and monitoring. Multifactorial causation may underlie the cognitive impairments.

OUTLOOK

Targeted longitudinal studies are necessary in order to identify the affected cognitive functions and be able to make causal inferences on links between the burnout syndrome and specific cognitive impairments.

Shifting of attentional set is inadequate in severe burnout: Evidence from an event-related potential study

Individuals with prolonged occupational stress often report difficulties in concentration. Work tasks often require the ability to switch back and forth between different contexts. Here, we studied the association between job burnout and task switching by recording event-related potentials (ERPs) time-locked to stimulus onset during a task with simultaneous cue-target presentation and unpredictable switches in the task. Participants were currently working people with severe, mild, or no burnout symptoms. In all groups, task performance was substantially slower immediately after task switch than during task repetition. However, the error rates were higher in the severe burnout group than in the mild burnout and control groups. Electrophysiological data revealed an increased parietal P3 response for the switch trials relative to repetition trials. Notably, the response was smaller in amplitude in the severe burnout group than in the other groups. The results suggest that severe burnout is associated with inadequate processing when rapid shifting of attention between tasks is required resulting in less accurate performance.

Job burnout is associated with dysfunctions in brain mechanisms of voluntary and involuntary attention

Individuals with job burnout symptoms often report having cognitive difficulties, but related electrophysiological studies are scarce. We assessed the impact of burnout on performing a visual task with varying memory loads, and on involuntary attention switch to distractor sounds using scalp recordings of event-related potentials (ERPs). Task performance was comparable between burnout and control groups. The distractor sounds elicited a P3a response, which was reduced in the burnout group. This suggests burnout-related deficits in processing novel and potentially important events during task performance. In the burnout group, we also observed a decrease in working-memory related P3b responses over posterior scalp and increase over frontal areas. These results suggest that burnout is associated with deficits in cognitive control needed to monitor and update information in working memory. Successful task performance in burnout might require additional recruitment of anterior regions to compensate the decrement in posterior activity.

Cognitive performance in both clinical and non-clinical burnout

Relatively little is known about cognitive performance in burnout. The aim of the present study was to further our knowledge on this topic by examining, in one study, cognitive performance in both clinical and non-clinical burnout while focusing on three interrelated aspects of cognitive performance, namely, self-reported cognitive problems, cognitive test performance, and subjective costs associated with cognitive test performance. To this aim, a clinical burnout patient group (n = 33), a non-clinical burnout group (n = 29), and a healthy control group (n = 30) were compared on self-reported cognitive problems, assessed by a questionnaire, as well as on cognitive test performance, assessed with a cognitive test battery measuring both executive functioning and more general cognitive processing. Self-reported fatigue, motivation, effort and demands were assessed to compare the different groups on subjective costs associated with cognitive test performance. The results indicated that the clinical burnout patients reported more cognitive problems than the individuals with non-clinical burnout, who in turn reported more cognitive problems relative to the healthy controls. Evidence for impaired cognitive test performance was only found in the clinical burnout patients. Relative to the healthy controls, these patients displayed some evidence of impaired general cognitive processing, reflected in slower reaction times, but no impaired executive functioning. However, cognitive test performance of the clinical burnout patients was related to larger reported subjective costs. In conclusion, although both the clinical and the non-clinical burnout group reported cognitive problems, evidence for a relatively mild impaired cognitive test performance and larger reported subjective cost associated with cognitive test performance was only found for the clinical burnout group.

Effects of perceived long-term stress on subjective and objective aspects of memory and cognitive functioning in a middle-aged population-based sample

The longitudinal effects of perceived stress on measures of memory and two other cognitive functions (word fluency, visuospatial ability) in a middle-aged sample (40-60 years, M age = 47.1 years, SD = 6.1 years; n = 192) were examined. A group describing themselves as stressed in general at baseline, and at follow-up measurement 5 and 10 years later (n = 96) was compared with a matched (age, sex) low-stress group (n = 96). The results revealed more depressive symptoms over time in the high-stress group. With regard to memory, a dissociation between subjective and objective measures was observed. Specifically, participants in the high-stress group rated their memory as worse over time as compared with controls, and reported a higher frequency of occurrence of everyday memory failures, effects partly independent of depressive symptoms. However, the groups did not differ in terms of objective episodic memory performance, word fluency or block design performance, with stable levels of performance over time regardless of perceived stress. The lack of effects of stress on cognitive performance is discussed in the light of factors such as stress level, age of the participants, and other individual difference factors.