Burnout and depression: Points of convergence and divergence

Vascular Surgeon Burnout in Chile: A Cross-Sectional National Study

BACKGROUND

The purpose of the study is to describe burnout in vascular surgeons (VS) in Chile and to determine their associated factors.

METHODS

Between April and June 2023, accredited Chilean VS were electronically surveyed. The results were analyzed with bivariate analysis and multivariate logistic regression, considering P value <0.05 as significant.

RESULTS

Of the 129 accredited VS in Chile, 113 (87.6%) responded, and after excluding 4 retired surgeons and 1 incomplete survey, 108 responses were analyzed representing 83.7% of those invited to participate. Mean age was 49.1 ± 9.9 years, most were male (85.2%), married/had a partner (83.0%) and had at least 1 child (82.4%). Overall, 62 (57.4%) of respondents had at least 1 symptom of burnout, 25 (23.1%) were at risk for depression, 11 (10.2%) screened positive for depression, and 5 (4.6%) had considered suicide in the last 12 months. In bivariate analysis, factors significantly associated with burnout were younger age, fewer years in practice, recent work-life conflict, degree of fatigue, job satisfaction, with or at risk for depression, sleep problems, lack of vacation time and the specific stressors. In the multivariate analysis, the significant factors were degree of fatigue, degree of resilience, desire for their children to pursue the same career as them, lack of sports or routine exercise, amount of vacation time, and adversities to perform the work at the hospital or clinic.

CONCLUSION

Burnout is highly prevalent in VS in Chile. Risk factors are like those described in the United States and Europe, the most relevant and distinctive being stress generated by work difficulties in hospitals.

The association between hair cortisol and burnout is moderated by age, psychosocial, and immunological markers

Background

Exhaustion and depersonalization are the core symptoms of the occupational burnout. However, burnout is not an all-or-nothing phenomenon, but can occur in a milder to moderate form in otherwise healthy employees. In the last two decades hair cortisol concentrations (HCC) were increasingly related to the cumulative effect of psychosocial stress at work. We analyzed data of the Dortmund Vital Study (Clinicaltrials.gov: NCT05155397) to explore the relationship of HCC and burnout symptoms. Moreover, we asked whether the HCC - burnout association was moderated by work ability, chronic stress, neuroticism, depressive symptoms, and stress-related immunological biomarkers such as T cell concentration, CD4/CD8 cell ratio, and proinflammatory cytokines TNF- α, IL-6, and IL-18.

Methods

Burnout was assessed by the Oldenburg Burnout Inventory (OLBI), and the Maslach Burnout Inventory (MBI-D) in 196 working adults aged between 20 and 65 years (mean age 42.2 years). Several self-reported variables and biomarkers were collected.

Results

The results showed an association between HCC and the burnout measures. A series of moderator analyses revealed that the association between HCC and burnout symptoms was substantial for low work ability, high chronic stress level, high neuroticism level, and mild to moderate depressive symptoms. Immunological markers moderated the HCC - burnout association for high concentrations of T cells, low CD4/CD8 ratio and low IL-6, IL-18 and TNF-α concentrations. These interactions were moderated by age showing the largest impact in middle-aged to older individuals.

Conclusions

The present findings shed light on the complex interaction between burnout symptoms and work ability, chronic stress, personality, and the endocrinological and immunological responses across the working lifespan. These parameters should be considered when assessing the risk for developing burnout and validating the diagnosis of burnout.

Trial registration

ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397.

Topography of depressive experiences. A dialectic approach

This article aims to offer clinical descriptions and philosophical interpretations of the ontological nature of depressive experiences trying to address issues related to the contemporary diagnostic paradigm and values-based practices which shape clinical decisions. At the core of this contribution there is the idea that the variety of depressive experiences might be understood acknowledging the qualitative difference in the ontology underlying each form of depression. We argue that there is a fundamental difference between melancholia as a disease and those melancholic traits which characterizes human existence as such: while the former indicates a qualitative alteration of the global human experience, constituting psychopathological experience, the latter describes a style of disproportion of existence not pathological per se at all. Moreover, we defend the hypothesis that melancholia (in a medical sense) is a distinct unity of mental alteration, and should not be conflated with the multivarious kind of experiences merged under the name of depression, the variety of which may be understood as disorders of the personal development. It is in this context that the leading element of anthropological disproportions impact the role of pre-reflective and transcendental structures, polarizing the self and the world in a three-way topography: 1. depression as an excessive symmetric proportion between self and world; 2. depression as a disproportion between the self and the world (detriment of the self); 3. depressions as impoverishment of the transcendental value of the world.

Latent profile analysis of burnout, depression, and anxiety symptoms among Chinese medical staff with frontline anti-epidemic experience in the post-COVID-19 pandemic era

Background

Frontline medical staff's psychological symptoms deserve persistent attention after 3 years of high-pressure and high-intensity work during the pandemic. In addition, the meaning of burnout and its relationship with depression and anxiety have long been debated. This study aimed to identify profiles of these symptoms among Chinese medical staff with frontline anti-epidemic experience, along with their distinguishing characteristics.

Methods

Psychological symptoms of burnout (exhaustion, cynicism, and inefficacy), depression, and anxiety from 989 doctors and 1,105 nurses were explored with latent profile analysis. The R3step method was conducted to analyze the predictive factors of those medical staff's symptoms.

Results

Three symptom profiles were identified for medical staff, with high-level (62.1%), moderate-level (28.9%), and low-level symptoms (9.0%). In the low-level and moderate-level profiles, symptom variables considered had a consistent trend. However, within the high-level profile, the inefficacy of burnout remained at a lower level, and anxiety performed as the most prominent symptom. Variables of gender, age, salary satisfaction, work hours, and work intensity predicted medical staff profiles (p < 0.05).

Conclusion

In the post-COVID-19 era, former frontline Chinese medical staff's psychological symptoms were divided into three latent profiles. Symptoms of burnout, depression, and anxiety did not move in lock-step, indicating that they are different and robust constructs. Targeted intervention strategies should be developed for different subgroups.

Correlates of burnout and dropout intentions in medical students: A cross-sectional study

BACKGROUND

Burnout is a pervasive issue among medical students, exhibiting a high prevalence that jeopardizes their academic success and may also predispose them to more severe affective disorders such as depression. This study aims to explore the complex relationships between psychological capital (PsyCap), general social support, educational satisfaction, and burnout, and how these factors collectively influence dropout intentions.

METHODS

A non-probabilistic convenience sample was collected through an online survey from first- and second-year medical students at a Faculty of Medicine in Portugal. The survey employed psychometric instruments to measure burnout (BAT-12), social support (F-SozU K-6), PsyCap (CPC-12R), satisfaction with education, and dropout intentions (Screening Instrument for Students At-Risk of Dropping Out). Structural equation modeling was applied to analyze the data from 351 participants.

RESULTS

The model demonstrated a significant positive association between burnout and dropout intentions (β̂ = 0.37; p < 0.001), underscoring burnout as a direct correlate of dropout intentions alongside educational satisfaction (β̂ = -0.25; p = 0.003) and PsyCap (β̂ = -0.22; p = 0.005). Higher social support is associated with reduced burnout (β̂ = -0.28; p < 0.001) and increased educational satisfaction (β̂ = 0.22; p = 0.002).

LIMITATIONS

The non-probabilistic sampling method prevents the generalization of the findings. The cross-sectional data do not permit the inference of temporal relationships between the studied variables.

CONCLUSIONS

These findings emphasize the importance that burnout may have on dropout intentions, and contribute to the understanding of affective syndromes such as burnout in educational settings.

Differentiating 'pure' and comorbid self-identified burnout: Diagnostic and management implications

OBJECTIVE

A previous study identified categorically differing scores on the Sydney Burnout Measure (SBM) between individuals with self-identified burnout with (n = 354) or without (n = 188) a history of mental illness. The current study examined whether the SBM's validity held in both scenarios.

METHOD

The factorial structure and scores on the SBM measure were compared between the two groups.

RESULTS

Similar underlying symptom constructs were identified. The group with a mental illness history had higher general factor scores, suggesting more severe burnout. The group without such a history (and thus a 'purer' burnout state) had higher scores on the empathy loss factor, suggesting its greater specificity to burnout than to other psychological states.

CONCLUSIONS

Burnout appears to be experienced similarly by those with and without a mental illness history as measured by the SBM.