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De Beer LT, Hakanen JJ, Schaufeli WB, De Witte H, Glaser J, Kaltiainen J, Seubert C, Morin AJS. The burnout-depression conundrum: investigating construct-relevant multidimensionality across four countries and four patient samples. Psychol Health 2024:1-28. [PMID: 38400520 DOI: 10.1080/08870446.2024.2321358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
This research seeks to contribute to the ongoing discussion about the distinctive nature of burnout and depression. In a first study, we relied on employee samples from four European countries (N = 5199; 51.27% women; Mage = 43.14). In a second study, we relied on a large sample of patients (N = 5791; 53.70% women; Mage = 39.54) who received a diagnosis of burnout, depressive episode, job strain, or adaptation disorder. Across all samples and subsamples, we relied on the bifactor exploratory structural equation modelling to achieve an optimal disaggregation of the variance shared across our measures of burnout and depression from the variance uniquely associated with each specific subscale included in these measures. Our results supported the value of this representation of participants' responses, as well as their invariance across samples. More precisely, our results revealed a strong underlying global factor representing participants' levels of psychological distress, as well as the presence of equally strong specific factors supporting the distinctive nature of burnout and depression. This means that, although both conditions share common ground (i.e. psychological distress), they are not redundant. Interestingly, our results also unexpectedly suggested that suicidal ideation might represent a distinctive core component of depression.
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Affiliation(s)
- Leon T De Beer
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- WorkWell Research Unit, North-West University, Potchefstroom, South Africa
| | - Jari J Hakanen
- Workability and Work Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Wilmar B Schaufeli
- Research Unit Occupational & Organizational Psychology and Professional Learning, KU Leuven, Leuven, Belgium
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Hans De Witte
- Research Unit Occupational & Organizational Psychology and Professional Learning, KU Leuven, Leuven, Belgium
- Optentia Research Unit, Vanderbijlpark Campus, North-West University, Vanderbijlpark, South Africa
| | - Jürgen Glaser
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Janne Kaltiainen
- Workability and Work Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Christian Seubert
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Alexandre J S Morin
- Substantive Methodological Synergy Research Laboratory, Concordia University, Montreal, Canada
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Tavella G, Hadzi-Pavlovic D, Bayes A, Jebejian A, Manicavasagar V, Walker P, Parker G. Burnout and depression: Points of convergence and divergence. J Affect Disord 2023; 339:561-570. [PMID: 37479038 DOI: 10.1016/j.jad.2023.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
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.
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Affiliation(s)
- Gabriela Tavella
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Dusan Hadzi-Pavlovic
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Adam Bayes
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Black Dog Institute, Hospital Rd, Randwick, New South Wales, Australia
| | - Artin Jebejian
- Gordon Private Hospital, Sydney, New South Wales, Australia
| | - Vijaya Manicavasagar
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Black Dog Institute, Hospital Rd, Randwick, New South Wales, Australia
| | - Peter Walker
- Lumiere Clinical Psychology, Sydney, New South Wales, Australia
| | - Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Gordon Private Hospital, Sydney, New South Wales, Australia.
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Bianchi R, Wac K, Sowden JF, Schonfeld IS. Burned-out with burnout? Insights from historical analysis. Front Psychol 2022; 13:993208. [PMID: 36405183 PMCID: PMC9667275 DOI: 10.3389/fpsyg.2022.993208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Fierce debates surround the conceptualization and measurement of job-related distress in occupational health science. The use of burnout as an index of job-related distress, though commonplace, has increasingly been called into question. In this paper, we first highlight foundational problems that undermine the burnout construct and its legacy measure, the Maslach Burnout Inventory (MBI). Next, we report on advances in research on job-related distress that depart from the use of the burnout construct. Tracing the genesis of the burnout construct, we observe that (a) burnout's definition was preestablished rather than derived from a rigorous research process and (b) the MBI has little in the way of a theoretical or empirical foundation. Historical analysis suggests that the burnout construct was cobbled together from unchallenged personal impressions and anecdotal evidence before getting reified by the MBI. This state of affairs may account for many of the disconcerting problems encountered in burnout research. We close our paper by presenting the Occupational Depression Inventory (ODI), a recently developed instrument reflective of a renewed approach to job-related distress. The ODI has demonstrated robust psychometric and structural properties across countries, sexes, age groups, occupations, and languages. The instrument addresses job-related distress both dimensionally and categorically. A dimensional approach can be useful, for instance, in examining the dynamics of etiological processes and symptom development. A categorical approach can serve screening and diagnostic purposes and help clinicians and public health professionals in their decision-making. It is concluded that the ODI offers occupational health specialists a promising way forward.
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Affiliation(s)
- Renzo Bianchi
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Affiliation(s)
- Scott T Meier
- Department of Counseling, School and Educational Psychology, The State University of New York at Buffalo, Buffalo, NY, United States of America.
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Nadon L, De Beer LT, Morin AJS. Should Burnout Be Conceptualized as a Mental Disorder? Behav Sci (Basel) 2022; 12:bs12030082. [PMID: 35323401 PMCID: PMC8945132 DOI: 10.3390/bs12030082] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023] Open
Abstract
Burnout is generally acknowledged by researchers, clinicians, and the public as a pervasive occupational difficulty. Despite this widespread recognition, longstanding debates remain within the scientific community regarding its definition and the appropriateness of classifying burnout as its own pathological entity. The current review seeks to address whether burnout should (or could) be characterized as a distinctive mental disorder to shed light on this debate. After briefly reviewing the history, theoretical underpinnings, and measurement of burnout, we more systematically consider the current evidence for and against its classification as a mental disorder within existing diagnostic systems. Stemming from a lack of conceptual clarity, the current state of burnout research remains, unfortunately, largely circular and riddled with measurement issues. As a result, information regarding the unique biopsychosocial etiology, diagnostic features, differential diagnostic criteria, and prevalence rates of burnout are still lacking. Therefore, we conclude that it would be inappropriate, if not premature, to introduce burnout as a distinct mental disorder within any existing diagnostic classification system. We argue, however, that it would be equally premature to discard burnout as a psychologically relevant phenomenon and that current evidence does support its relevance as an important occupational syndrome. We finally offer several avenues for future research, calling for cross-national collaboration to clarify conceptual and measurement issues while avoiding the reification of outdated definitions. In doing so, we hope that it one day becomes possible to more systematically re-assess the relevance of burnout as a distinctive diagnostic category.
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Affiliation(s)
- Lindsey Nadon
- Substantive Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, QC H4B 1R6, Canada; (L.N.); (A.J.S.M.)
| | - Leon T. De Beer
- WorkWell Research Unit, Faculty of Economic and Management Sciences, North-West University, Potchefstroom 2531, South Africa
- Correspondence:
| | - Alexandre J. S. Morin
- Substantive Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, QC H4B 1R6, Canada; (L.N.); (A.J.S.M.)
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7
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Khammissa RAG, Nemutandani S, Shangase SL, Feller G, Lemmer J, Feller L. The burnout construct with reference to healthcare providers: A narrative review. SAGE Open Med 2022; 10:20503121221083080. [PMID: 35646362 PMCID: PMC9133861 DOI: 10.1177/20503121221083080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.
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Affiliation(s)
- Razia AG Khammissa
- School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Simon Nemutandani
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | | | - Gal Feller
- Department of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Johan Lemmer
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Liviu Feller
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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8
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McFarland DC, Hlubocky F. Therapeutic Strategies to Tackle Burnout and Emotional Exhaustion in Frontline Medical Staff: Narrative Review. Psychol Res Behav Manag 2021; 14:1429-1436. [PMID: 34552358 PMCID: PMC8450185 DOI: 10.2147/prbm.s256228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Burnout and emotional exhaustion in frontline healthcare workers and their implications for the health of patients, individual clinicians, and organizations are increasingly described among various healthcare settings. Yet therapeutic strategies to address burnout and other work-related conditions are outpaced by innumerable descriptions of burnout prevalence across healthcare disciplines. This review provides a framework that should be helpful in beginning the process of addressing burnout and its related conditions. It begins with an elucidation of key inter-related concepts of work-related conditions that should be considered in the differential diagnosis along with other mental health conditions that are concomitantly elevated in healthcare clinicians (eg, depression and substance abuse) but require a different approach to treatment. Factors that lead to increased resilience, engagement, and thriving in clinical workplaces are considered. While strategies are dichotomized between organizational level interventions and individual or personal interventions to address burnout, the idea of identifying and addressing root causes of burnout and related conditions is highlighted. The efficacy and feasibility of interventions that incorporate mindfulness-based stress reduction, cognitive behavioral strategies, meaning-centered therapy, and compassion training are highlighted as interventions with proven efficacy and durability that should be considered based on work-related stressors and appeal to clinicians.
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Affiliation(s)
- Daniel C McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, NY, USA
| | - Fay Hlubocky
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, MacLean Center for Clinical Medical Ethics, and the Cancer Research Center, Chicago, IL, USA
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Tóth‐Király I, Morin AJ, Salmela‐Aro K. Reciprocal Associations between Burnout and Depression: An 8‐Year Longitudinal Study. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2021. [DOI: 10.1111/apps.12295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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10
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Coetzee JF, Kluyts H. Burnout and areas of work-life among anaesthetists in South Africa Part 1 : Burnout. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.2.2358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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McFarland DC, Hlubocky F, Susaimanickam B, O'Hanlon R, Riba M. Addressing Depression, Burnout, and Suicide in Oncology Physicians. Am Soc Clin Oncol Educ Book 2019; 39:590-598. [PMID: 31099650 DOI: 10.1200/edbk_239087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.
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Affiliation(s)
- Daniel C McFarland
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fay Hlubocky
- 2 Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Bibiana Susaimanickam
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin O'Hanlon
- 3 Medical Library, Memorial Sloan Kettering Cancer Center. New York, NY
| | - Michelle Riba
- 4 University of Michigan Department of Psychiatry and University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Sinval J, Queirós C, Pasian S, Marôco J. Transcultural Adaptation of the Oldenburg Burnout Inventory (OLBI) for Brazil and Portugal. Front Psychol 2019; 10:338. [PMID: 30914985 PMCID: PMC6422925 DOI: 10.3389/fpsyg.2019.00338] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
During the last few years, burnout has gained more and more attention for its strong connection with job performance, absenteeism, and presenteeism. It is a psychological phenomenon that depends on occupation, also presenting differences between sexes. However, to properly compare the burnout levels of different groups, a psychometric instrument with adequate validity evidence should be selected (i.e., with measurement invariance). This paper aims to describe the psychometric properties of the Oldenburg Burnout Inventory (OLBI) version adapted for workers from Brazil and Portugal, and to compare burnout across countries and sexes. OLBI's validity evidence based on the internal structure (dimensionality, reliability, and measurement invariance), and validity evidence based on relationships with other variables (work engagement) are described. Additionally, it aims presents a revision of different OLBI's versions-since this is the first version of the instrument developed simultaneously for both countries-it is an important instrument for understanding burnout between sexes in organizations. Data were used from 1,172 employees across two independent samples, one from Portugal and the other from Brazil, 65 percent being female. Regarding the OLBI internal structure, a reduced version (15 items) was obtained. The high correlation between disengagement and exhaustion, suggested the existence of a second-order latent factor, burnout, which presented measurement invariance for country and sex. Confirmatory factor analysis of the Portuguese OLBI version presented good goodness-of-fit indices and good internal consistency values. No statistically significant differences were found in burnout between sexes or countries. OLBI also showed psychometric properties that make it a promising and freely available instrument to measure and compare burnout levels of Portuguese and Brazilian employees.
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Affiliation(s)
- Jorge Sinval
- William James Center for Research, ISPA – Instituto Universitário, Lisbon, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Cristina Queirós
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Sonia Pasian
- Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - João Marôco
- William James Center for Research, ISPA – Instituto Universitário, Lisbon, Portugal
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Gajewski PD, Boden S, Freude G, Potter GG, Claus M, Bröde P, Watzl C, Getzmann S, Falkenstein M. Executive control, ERP and pro-inflammatory activity in emotionally exhausted middle-aged employees. Comparison between subclinical burnout and mild to moderate depression. Psychoneuroendocrinology 2017; 86:176-186. [PMID: 28972891 DOI: 10.1016/j.psyneuen.2017.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/01/2017] [Accepted: 09/14/2017] [Indexed: 01/11/2023]
Abstract
Burnout is a syndrome occurring mainly in individuals with long-term stressful work. The main complaints are emotional exhaustion and reduced performance. Burnout also largely overlaps with depression. Both are characterized by increased incidence of infections due to dysregulation of the immune system, overexpression of pro-inflammatory cytokines and cognitive deficits, particularly related to executive functions. To distinguish between burnout and depression already at the pre-clinical stage, the present double-blinded study compared immunological and cognitive parameters in seventy-six employees from emotionally demanding occupations who were post-hoc subdivided into two groups scoring low (EE-) and high (EE+) in emotional exhaustion and low (DE-) and high (DE+) in depression. Immunological parameters were measured from blood samples. Executive functions were studied by analyzing event-related brain potentials (ERPs) and performance during a task switching paradigm. Psychosocial job parameters were measured with standardized questionnaires. Burnout and mild to moderate depression largely overlapped. However, several subjects showed burnout without depressive symptoms. Higher levels of the pro-inflammatory cytokines IL-6 and IL-12 were correlated with burnout severity and depressive symptoms in male individuals. In the switch task a trend for lower performance in the EE+ vs. EE- group and no difference between DE+ and DE- groups were found. In the ERPs, however, differences were observed which distinguished between subclinical burnout and depression: the terminal contingent negative variation (CNV), indicating preparatory activity and the P3b, related to allocation of cognitive resources were generally reduced in EE+ vs. EE-, whereas no differences were found in the DE+ vs. DE- groups. The frontal P3a was selectively reduced in switch trials in the EE+ vs. EE- group and showed only a trend in DE+ vs. DE-, indicating impairment of executive control in subclinical burnout. Taken together, the results unveil specific immunological changes and declines in brain functions in employees with subclinical burnout that are not apparent in persons with moderate depression. Hence, the combination of immunological, behavioral and ERP methods renders a promising method for distinguishing both syndromes and for improving an early diagnosis of burnout before a clinical stage is reached.
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Affiliation(s)
- Patrick D Gajewski
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1.
| | - Sylvia Boden
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Gabriele Freude
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Guy G Potter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Maren Claus
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Peter Bröde
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Carsten Watzl
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Stephan Getzmann
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Michael Falkenstein
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1; Institute for Working, Learning and Aging, Bochum, Germany
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14
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Sun JW, Lin PZ, Zhang HH, Li JH, Cao FL. A non-linear relationship between the cumulative exposure to occupational stressors and nurses' burnout and the potentially emotion regulation factors. J Ment Health 2017; 27:409-415. [PMID: 28990445 DOI: 10.1080/09638237.2017.1385740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stressful situations can increase the likelihood of nurses experiencing negative emotions, especially burnout. AIMS To explore the association of cumulative exposure to occupational stressors and emotion regulation strategies with nurses' burnout. METHODS Participants were 602 nurses from three general hospitals in Jinan, China. Social demographic characteristics, occupational stress, burnout, and emotion regulation strategies (cognitive reappraisal, expressive suppression, and rumination), were assessed. RESULTS Nearly 70% of nurses reported that they were burnt out. Those with a moderate level and high level of stressors were 3.203 times and 26.444 times more likely to have burnout, respectively (x2trend = 62.732). Logistic regression revealed that nurses had higher cognitive reappraisal score (odds ratios (OR) = 0.941), scored lower for burnout. Those who had higher expressive suppression score (OR = 1.054), higher rumination score (OR = 1.037), and a higher level of stressors (OR = 2.779-18.259) scored higher for burnout. The results of sensitivity analysis were similar. CONCLUSIONS A non-linear relationship exists between the cumulative exposure to occupational stressors and nurses' burnout. Those who less frequently use cognitive reappraisal, more frequently use rumination and expressive suppression, and have a high level of stressors may be more likely to experience burnout.
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Affiliation(s)
- Ji-Wei Sun
- a School of Nursing, Shandong University , Jinan , China
| | - Ping-Zhen Lin
- a School of Nursing, Shandong University , Jinan , China
| | - Hui-Hui Zhang
- a School of Nursing, Shandong University , Jinan , China
| | - Jia-Huan Li
- a School of Nursing, Shandong University , Jinan , China
| | - Feng-Lin Cao
- a School of Nursing, Shandong University , Jinan , China
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15
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Melnick ER, Powsner SM, Shanafelt TD. In Reply-Defining Physician Burnout, and Differentiating Between Burnout and Depression. Mayo Clin Proc 2017; 92:1456-1458. [PMID: 28870365 DOI: 10.1016/j.mayocp.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 10/24/2022]
Affiliation(s)
- Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Seth M Powsner
- Department of Psychiatry and Emergency Medicine, Yale School of Medicine, New Haven, CT
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16
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Bianchi R, Schonfeld IS, Laurent E. Burnout or depression: both individual and social issue. Lancet 2017; 390:230. [PMID: 28721879 DOI: 10.1016/s0140-6736(17)31606-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Renzo Bianchi
- University of Neuchâtel, Institute of Work and Organizational Psychology, 2000 Neuchâtel, Switzerland.
| | - Irvin Sam Schonfeld
- The City College of the City University of New York, Department of Psychology, New York, NY, USA
| | - Eric Laurent
- Bourgogne Franche-Comté University, Laboratory of Psychology, Besançon, France
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