The psychobiology of burnout: are there two different syndromes?

Burnout Syndrome in forensic medicine and its association with vicarious trauma, posttraumatic stress syndrome and occupational stress

The burnout phenomenon is a subject of considerable interest due to its impact on both employee well-being and scientific inquiry. Workplace factors, both intrinsic and extrinsic, play a pivotal role in its development, often leading to job dissatisfaction and heightened burnout risk. Chronic stress and burnout induce significant dysregulation in the autonomic nervous system and hormonal pathways, alongside structural brain changes. This paper presents a preliminary review of the literature on burnout syndrome among forensic science workers, focusing on the prevalence of this phenomenon and its triggers. This review aims to consolidate existing research on burnout among forensic medicine workers, highlight significant findings, and encourage further studies. Symptoms range from demoralization to somatic complaints. The Maslach Burnout Inventory (MBI) was the main tool in assessing burnout levels alongside measures of occupational stress, vicarious trauma and posttraumatic stress syndrome. Forensic medicine workers face unique stressors, with notable impacts on burnout levels. These workers experience challenges such as workplace conflicts and exposure to traumatic cases, leading to moderate or high burnout levels, particularly, emotional exhaustion, depersonalization or low personal accomplishment. Despite the prevalence of burnout, many forensic medicine workers lack access to support networks and perceive a disregard for their well-being from supervisors. There is a pressing need for further research to understand the biological mechanisms, susceptibility factors, and discover diagnostic markers of burnout syndrome, with the goal of its recognition as a psychiatric disorder in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders.

The Role of Guilt Feelings in the Development of the Burnout Process: The Influence on Psychosomatic Problems

Burnout is a psychological consequence of prolonged work-related stress. Previous studies have concluded that guilt feelings could explain the development of the burnout process and its relationship with other health disorders. The aim of this study was to evaluate the mediating role of guilt feelings in the relationship between burnout and psychosomatic problems. The sample comprised 714 Brazilian teachers (82.10% women). Burnout was assessed using the Spanish Burnout Inventory (SBI). The hypotheses were evaluated together using a path model to test the mediating role of guilt feelings in the development of burnout and its relationship with psychosomatic problems. Two models were constructed: the hypothesized model (i.e., indolence → guilt → psychosomatic problems) vs. the alternative model (i.e., indolence → psychosomatic problems → guilt). According to the results, the hypothesized model obtained a satisfactory fit to the data, whereas the alternative model's fit was found to be inadequate. We concluded that the hypothesized model was a good representation of the relationship among burnout, guilt feelings and psychosomatic problems. We recommend taking into consideration feelings of guilt to improve the diagnosis of burnout.

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.

Fatigue and Its Contributing Factors in Chinese Patients with Primary Pituitary Adenomas

BACKGROUND

Pituitary adenomas (PAs) refers to a group of benign tumors that develop in the pituitary gland and are often characterized by fatigue. However, fatigue has not been documented in any Chinese research involving people with primary PA. The study sought to examine the prevalence, predictors, and correlation of fatigue with the quality of life (QoL) among PA patients in China.

METHODS

In total, 203 primary PA patients were included in this cross-sectional study. A series of questionnaires were administered, including the Multidimensional Fatigue Inventory (MFI), M. D. Anderson Symptom Inventory Brain Tumor (MDASI-BT), Short-Form 36 Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Data analysis was accomplished by Pearson or Spearman correlations, linear regression, and simple path analysis.

RESULTS

Severe fatigue prior to the initial diagnosis and preparation for surgery affected 50% of PA patients. Depression, sleep disturbance, and MDASI-BT symptom total scores were independently able to predict patient fatigue. Sleep disturbance mediates the influence of depression on fatigue (IE sleep = 0.296, 95% CI: LB = 0.148 to UB = 0.471).

CONCLUSIONS

Chinese patients with primary PA often report experiencing fatigue. Depression and poor sleep quality were shown to be significant contributors to PA patients' fatigue. Depression affects PA patients' fatigue directly or indirectly. Medical professionals should take a proactive approach to PA patients suffering from fatigue before initial diagnosis and preoperative preparation to determine necessary interventions early, thus reducing fatigue and ultimately enhancing their QoL.

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.

Influence of Burnout and Feelings of Guilt on Depression and Health in Anesthesiologists

BACKGROUND AND OBJECTIVE

The WHO has included burnout as an occupational phenomenon in the ICD-11. According to the WHO, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. The study aimed to evaluate the influence of feelings of guilt and burnout on health in Polish anesthesiologists. Alcohol and tobacco intake, psychosomatic disorders, and depression were assessed.

METHODS

The study had a non-randomized cross-sectional character. The sample consisted of 372 Polish anesthesiologists. Burnout was measured by the Spanish burnout inventory.

RESULTS

Post hoc analysis for burnout consequences: depression (F(5,366) = 17.51, p < 0.001, ηp2 = 0.193), psychosomatic disorders (F(5,366) = 13.11, p < 0.001, ηp2 = 0.152), and tobacco intake (F(5,366) = 6.23, p < 0.001, ηp2 = 0.078), showed significant differences between burnout with and without the highest levels of feelings of guilt. All the instruments applied were reliable.

CONCLUSIONS

Depression, psychosomatic disorders, and alcohol and tobacco intake are suspected to be consequences of the highest guilt levels related to burnout, i.e., Profile 2 according to the burnout model of Gil-Monte. Participation in prevention programs is recommended for these cases.

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.

The Association between Energy Balance-Related Behavior and Burn-Out in Adults: A Systematic Review

Although it is believed that physical activity, sedentary, and dietary behavior (i.e., energy balance-related behavior) may decrease the risk of burn-out, the association between both is currently not well understood. Therefore, the aim of this systematic review was to synthesize studies investigating the relationship between energy balance-related behavior and burn-out risk. A systematic literature search was conducted in four databases, resulting in 25 included studies (ten experimental and 15 observational studies). Nine out of ten experimental studies showed that exercise programs were effective in reducing burn-out risk. Fourteen out of fifteen observational studies found a negative association between physical activity and burn-out risk, whereas one study did not find a relation. Two of the 15 observational studies also showed that being more sedentary was associated with a higher burn-out risk, and two other studies found that a healthier diet was related to a lower burn-out risk. No experimental studies were found for the latter two behaviors. It can be concluded that physical activity may be effective in reducing burn-out risk. The few observational studies linking sedentary and dietary behavior with burn-out risk suggest that being more sedentary and eating less healthy are each associated with higher burn-out risk. More high-quality research is needed to unravel the causal relationship between these two behaviors and burn-out risk.

Depression, anxiety, and guilt in mothers with burnout of preschool and school-aged children: Insight from a cluster analysis

INTRODUCTION

The primary objective of this study is to identify the typology of exhausted mothers based on, depressive, anxiety, and guilt symptoms. And, secondarily, evaluate whether these profiles differ on parental stress, environmental stress, and parental burnout.

METHODS

Five hundred and fifty French-speaking mothers suffering from exhaustion completed several questionnaires assessing parental stress, general perceived stress, maternal guilt, and depressive and anxious symptomology. Results from two hundred and ten mothers with burnout symptoms were explored (mean age [SD] = 33.69 [5.1] years). In order to identify possible subgroups, a hierarchical cluster analysis was performed.

RESULTS

Three profiles were highlighted from the sample (Wilks' λ = 0.156, p < .0001): the first was characterized by high feelings of guilt (29.52%; n = 62), the second showed a dominance of anxiety symptoms and high feelings of guilt (36.19%; n = 76), and the fourth presented low levels of depression, anxiety, and feelings of guilt (23.3%, n = 49).

DISCUSSION

These findings suggest different profiles of burned out mothers that vary according to severity of anxiety, depression, and guilt. That suggests that parental burnout, depression and anxiety are distinct disorders. This study also makes it possible to show the aggravating effect of guilt in the experience of burnout. Additional research is warranted as it is important to more carefully consider possible appropriate intervention strategies given the differing experiences of burned out mothers.

Interactive effects of corticotropin-releasing hormone receptor 1 gene and work stress on burnout in medical professionals in a Chinese Han population

BACKGROUND

Burnout is a worked-related stress syndrome caused by long-term exposure to a stressful environment. Dysregulation of the hypothalamic- pituitary- adrenal (HPA) axis may be involved in both stress and burnout; an evaluation of genetic polymorphisms which alter activity in the HPA may be predictive of how likely an environment is to produce burnout.

METHODS

Using a cross-sectional design, this study examined whether corticotrophin-releasing hormone receptor 1 (CRHR1) gene polymorphism rs110402 is a risk factor for burnout; further, it explores whether the interaction of stress × CRHR1 gene predicts burnout in the healthcare workers in a Chinese Han population. House and Rizzo's work stress scale, Sources of Pressure Scale and Maslach Burnout Inventory-General Survey were administered to 712 participants from a large general hospital in Beijing. The CRHR1 rs110402 polymorphism was genotyped in 376 participants.

RESULTS

Our results showed significant positive inter-correlations between stressor, work stress and depressive scores (all p < 0.001) with only one exception. Males, younger age and higher educational level were associated with burnout (all p < 0.05). The presence of the CRHR1 rs110402 genotype was not correlated with the presence of job stress or burnout. However, we found statistically significant interaction between CRHR1 rs110402 and job stress on burnout (p < 0.05). Individuals homozygous for the A allele reported significantly higher emotional exhaustion than G allele carriers in the high stress group.

LIMITATIONS

The sample was only chosen from the medical professions, and the sample size was relatively small. Only one polymorphism in CRHR1 gene was analyzed, while only about half of the total individuals were genotyped.

CONCLUSIONS

Our results suggest a close relationship between work-related stress and burnout and that the A allele of the CRHR1 rs110402 polymorphism may enhance feelings of emotional exhaustion when experiencing work-related stress.

Burnout Syndrome in Physicians-Psychological Assessment and Biomarker Research

Background and objectives: Burnout is a syndrome typically occurring in work environments with continuous and chronic stress. Physicians are at increased risk for burnout, as a result of 24-h work, delayed work–life balance gratification, and the challenges associated with patient care. The aim of the present study was to evaluate the psychological parameters of burnout symptoms in relation to biomarkers of stress among physicians with different medical specialties. Materials and methods: A total of 303 physicians were contacted as potential participants. A comparison group of 111 individuals working outside medicine was used as a control to verify the results. The physicians were specialists in internal medicine, general surgery, pathology, and primary care. Serum cortisol, salivary cortisol, adrenocorticotropic hormone (ACTH), insulin (IRI), and prolactin levels were analyzed by chemiluminescence enzyme immunoassay (Access 2, Beckman Coulter). Fasting glucose in serum and glycated hemoglobin (HbA1C) in whole blood were measured using the automatic analyzer AU 480 Beckman Coulter system. Symptoms of burnout were measured with the Maslach Burnout Inventory (MBI). Results: The group with burnout presented significantly higher levels of serum and saliva cortisol, ACTH, prolactin, fasting glucose, and HbA1C compared with the control group. The correlation analysis between biomarkers showed a positive correlation with moderate strength between serum and saliva cortisol (r = 0.516, p = 0.01),as well as serum and saliva cortisol with ACTH (r = 0.418; r = 0.412, p = 0.01) and HbA1C (r = 0.382; r = 0.395, p = 0.01). A weak positive correlation was found between serum and saliva cortisol with prolactin (r = 0.236; r = 0.267, p < 0.01) and glucose (r = 0.271; r = 0.297, p < 0.01). In the multiple logistic regression model, saliva cortisol, HbA1C, and age were significantly associated with burnout (chi-square = 16.848, p < 0.032). Conclusion: Our findings demonstrated the interest of exploring biomarkers of stress related to burnout in health professionals.

Psychophysiological concomitants of burnout: Evidence for different subtypes

BACKGROUND

There is evidence that chronic stress and emotional exhaustion are related to physiological dysregulations, which could negatively impact physical and mental health. This study aimed to identify the specific physiological clusters which are most reliable and prominently associated with burnout. Emphasis was placed on variables of the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Burnout was assessed using the Emotional Exhaustion subscale of the German version of the Maslach Burnout Inventory (MBI-GS).

METHODS

A sample of 105 individuals aged between 28 and 60 years (M = 42.7, SD = 7.75) and working under highly demanding conditions participated in this study. 46 participants reported a low risk of burnout, and 58 participants a high risk. They underwent 24 h of ECG monitoring, had cortisol awakening response collected, and had blood pressure measured two times within a week.

RESULTS

Compromised HRV, higher cortisol values, and higher blood pressure were found in individuals with high burnout symptoms. Furthermore, a discriminant function analysis on cardiac and neuroendocrine variables suggested two subgroups within the high burnout individuals, with only one group showing evidence for autonomic dysfunction as indicated by lower vagal efference.

CONCLUSIONS

Results suggest that burnout might not necessarily imply physiological disturbances, thus calling for a more differentiated and individualized view of burnout.

MECHANISMS IN ENDOCRINOLOGY: Endocrine and immunological aspects of burnout: a narrative review

Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main endocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.

Limbic brain structures and burnout-A systematic review

More profound understanding of the relationship between the burnout and the limbic system function can provide better insight into brain structures associated with the burnout syndrome. The objective of this review is to explore all evidence of limbic brain structures associated with the burnout syndrome. In total, 13 studies were selected. Four of them applied the neuroimaging technology to investigate the sizes/volumes of the limbic brain structures of burnout patients. Six other studies were to investigate the hypothalamus-pituitary-adrenal (HPA) axis of burnout patients. Based on the results of the studies on the HPA-axis and neuroimaging of the limbic brain structures, one can see great impact of the chronic occupational stress on the limbic structures in terms of HPA dysregulation, a decrease of BDNF, impaired neurogenesis and limbic structures atrophy. It can be concluded that chronic stress inhibits the feedback control pathway in the HPA axis, causes the decrease of brain-derived neurotrophic factor (BDNF), then impaired neurogenesis and eventually neuron atrophy.

Prevalence of burnout in Polish anesthesiologists and anesthetist nursing professionals: A comparative non-randomized cross-sectional study

The purpose of the study was to assess the burnout levels in nurses ( N = 161) versus physicians ( N = 373). The levels of burnout were evaluated by the Polish adaptation of the Spanish Burnout Inventory (Cronbach's alpha > .70). High burnout level was found in 18.63 percent nurses and 12.06 percent anesthesiologists, and critical level in 3.74 percent nurses and 5.90 percent anesthetists. There were statistically significant differences in Burnout global score, Enthusiasm toward the job, Psychological exhaustion, and Indolence subscales between nurses and physicians. No significant differences were found between sexes in any variable.

Subgroup Analysis in Burnout: Relations Between Fatigue, Anxiety, and Depression

Several authors have suggested that burned out patients do not form a homogeneous group and that subgroups should be considered. The identification of these subgroups may contribute to a better understanding of the burnout construct and lead to more specific therapeutic interventions. Subgroup analysis may also help clarify whether burnout is a distinct entity and whether subgroups of burnout overlap with other disorders such as depression and chronic fatigue syndrome. In a group of 113 clinically diagnosed burned out patients, levels of fatigue, depression, and anxiety were assessed. In order to identify possible subgroups, we performed a two-step cluster analysis. The analysis revealed two clusters that differed from one another in terms of symptom severity on the three aforementioned measures. Depression appeared to be the strongest predictor of group membership. These results are considered in the light of the scientific debate on whether burnout can be distinguished from depression and whether burnout subtyping is useful. Finally, implications for clinical practice and future research are discussed.

Burnout-depression overlap: a review

Whether burnout is a form of depression or a distinct phenomenon is an object of controversy. The aim of the present article was to provide an up-to-date review of the literature dedicated to the question of burnout-depression overlap. A systematic literature search was carried out in PubMed, PsycINFO, and IngentaConnect. A total of 92 studies were identified as informing the issue of burnout-depression overlap. The current state of the art suggests that the distinction between burnout and depression is conceptually fragile. It is notably unclear how the state of burnout (i.e., the end stage of the burnout process) is conceived to differ from clinical depression. Empirically, evidence for the distinctiveness of the burnout phenomenon has been inconsistent, with the most recent studies casting doubt on that distinctiveness. The absence of consensual diagnostic criteria for burnout and burnout research's insufficient consideration of the heterogeneity of depressive disorders constitute major obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the seminal, field-dominating definition of burnout is questioned. It is suggested that systematic clinical observation should be given a central place in future research on burnout-depression overlap.

The mediating role of feelings of guilt in the relationship between burnout and the consumption of tobacco and alcohol

Earlier studies have shown that feelings of guilt appear to be involved in the burnout process. However, the exact nature of the relationship between burnout, feelings of guilt, and tobacco and alcohol use is unclear. The purpose of this study was to analyze the role of feelings of guilt in the relationship between burnout and the consumption of tobacco and alcohol. Role conflict, Role clarity, and Feedback were included as predictors of burnout. The sample of this cross‐sectional study consisted of 260 Chilean administration and customer service workers. Hypotheses were tested using a path model. The hypothesized model (i.e., Indolence to guilt to tobacco/alcohol use) showed an adequate data fit, including a mediator role of feelings of guilt in the relationship between burnout and alcohol use. The results of this study recommending taking into consideration the evaluation of feelings of guilt as a symptom of burnout in order to develop a more reliable diagnosis of burnout syndrome and its consequences.

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.

Burnout is associated with elevated prolactin levels in men but not in women

OBJECTIVE

Prolactin levels have been shown to be increased by different types of psychosocial stress. Since burnout is a consequence of long-term psychosocial stress, prolactin levels might also be affected in burnout. The aim of this study was to investigate whether there are differences in prolactin levels between individuals who report burnout and others.

METHOD

Morning fasting serum prolactin levels were compared between individuals who reported burnout (24 men and 25 women) and individuals who reported no burnout (25 men and 13 women). Women were tested in the follicular phase of the menstrual cycle. Men and women were analysed separately.

RESULTS

Men who reported burnout exhibited significantly higher (34%) serum prolactin levels compared to men who reported no burnout. The prolactin levels in women who reported burnout were not different from the levels in the women who reported no burnout before or after adjusting for estradiol levels.

CONCLUSIONS

This study indicates that prolactin levels are higher in men with burnout than men without burnout but not affected in women with burnout. Why no association was seen in women needs to be further explored.

Psychometric properties of the 'Spanish burnout inventory' among employees working with people with intellectual disability

BACKGROUND

Burnout has been recognised as an important stress-related problem for employees working with people with intellectual disability. Researchers have been troubled by some of the psychometric limitations of the questionnaires developed to evaluate burnout. This study was designed to assess the psychometric properties of the Spanish Burnout Inventory.

METHOD

The sample consisted of 697 Spanish employees working in intellectual disability services. The instrument is composed of 20 items distributed in four dimensions: Enthusiasm towards the job, Psychological exhaustion, Indolence and Guilt. The psychometric properties were examined through the following analyses: confirmatory factor analysis and reliability. To assess the factorial validity of the Spanish Burnout Inventory, four alternative models were tested.

RESULTS

The four-factor model obtained an adequate data fit for the sample. The four sub-scales exhibited high reliability, with Cronbach alphas exceeding the critical value of 0.70.

CONCLUSIONS

This study provides evidence showing the adequate psychometric properties of an alternative burnout measure that could facilitate the diagnosis of individuals with burnout. It recommends taking feelings of guilt into consideration in interventions designed to improve staff burnout.

Job Satisfaction and Cortisol Awakening Response in Teachers Scoring high and low on Burnout

The burnout syndrome is an important psychosocial risk in the job context, especially in professions with a strong social interaction, as in the case of teaching. High levels of burnout have been related to negative psychological indicators and hormonal alterations. This study compares job satisfaction and the cortisol awakening response (CAR) in teachers scoring high (HB) and low (LB) on burnout. HB teachers showed lower job satisfaction and no significant differences in the CAR when compared with the LB group. The results of the study suggest a general dissatisfaction with work along with a different functioning of the hypothalamo-pituitary-adrenocortical axis in HB teachers. Although non significantly, they showed a lower magnitude of the CAR than LB teachers. When considering the whole sample, emotional exhaustion and depersonalization correlated negatively and personal accomplishment positively with each subscale of the job satisfaction questionnaire whereas cortisol levels or CAR did not correlate significantly with both burnout subscales and job satisfaction. These results should be taken into account when working to prevent burnout in teachers, as the modified parameters could be considered indicators of the onset or development of the syndrome.

Understanding burnout according to individual differences: ongoing explanatory power evaluation of two models for measuring burnout types

Background

The classic determination of burnout is by means of the dimensions exhaustion, cynicism and inefficacy. A new definition of the syndrome is based on clinical subtypes, consisting of “frenetic” (involved, ambitious, overloaded), “underchallenged” (indifferent, bored, with lack of personal development) and “worn-out” (neglectful, unacknowledged, with little control). The dimensions of overload, lack of development and neglect form a shortened version of this perspective. The aims of this study were to estimate and to compare the explanatory power of both typological models, short and long, with the standard measurement.

Methods

This was a cross-sectional survey with a randomly sample of university employees (n=409). Multivariate linear regression models were constructed between the “Maslach Burnout Inventory General Survey” (MBI-GS) dimensions, as dependent variables, and the “Burnout Clinical Subtype Questionnaire” (BCSQ-36 and BCSQ-12) dimensions, as independent variables.

Results

The BCSQ-36 subscales together explained 53% of ‘exhaustion’ (p<0.001), 59% of ‘cynicism’ (p<0.001) and 37% of ‘efficacy’ (p<0.001), while BCSQ-12 subscales explained 44% of ‘exhaustion’ (p<0.001), 44% of ‘cynicism’ (p<0.001), and 30% of ‘efficacy’ (p<0.001). The difference in the explanatory power of both models was significant for ‘exhaustion’ (p<0.001), and for ‘cynicism’ (p<0.001) and ‘efficacy (p<0.001).

Conclusions

Both BCSQ-36 and BCSQ-12 demonstrate great explanatory power over the standard MBI-GS, while offering a useful characterization of the syndrome for the evaluation and design of interventions tailored to the characteristics of each individual. The BCSQ-36 may be very useful in mental health services, given that it provides a good deal of information, while the BCSQ-12 could be used as a screening measure in primary care consultations owing to its simplicity and functional nature.

Cortisol-induced increases of plasma oxytocin levels predict decreased immediate free recall of unpleasant words

Cortisol and oxytocin have been shown to interact in both the regulation of stress responses and in memory function. In the present study we administered cortisol to 35 healthy female subjects in a within-subject double-blind placebo-controlled design, while measuring oxytocin levels, adrenocorticotropic hormone (ACTH) levels, and free recall of pleasant and of unpleasant words. We found that cortisol administration suppressed ACTH levels and (1) induced a decrease in oxytocin associated with ACTH suppression and (2) an increase in oxytocin that was independent from ACTH suppression. This cortisol-induced increase in plasma oxytocin was associated with a selective decrease in immediate free recall of unpleasant words from primacy positions. The present results add to evidence that cortisol-induced increases in oxytocin could mediate some of the effects of stress and cortisol on memory, and possibly play a role in the regulation of the hypothalamo-pituitary-adrenal stress response. This mechanism could significantly impact affective and social behaviors, in particular during times of stress.

The Influence of Guilt on the Relationship Between Burnout and Depression

Burnout is a serious problem that can be expressed as psychological symptoms, such as depressive mood. 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 depression is unclear. The purpose of this study was to test the mediator role of guilt in the relationship between burnout and depression. The sample of this cross-sectional study consisted of 700 employees working with intellectually disabled persons. Hypotheses were tested together in a path model. Two models were constructed to test the relationships among the variables. The difference between the models was the order of the Guilt-Depression relationship. The Hypothesized model (i.e., Indolence → Guilt → Depression) showed an adequate fit to data, and all hypothesized relationships were significant. The fit of the Alternative model (i.e., Indolence → Depression → Guilt) was worse than the fit of the Hypothesized model. The hypothesized model offers a good representation of the relationships among burnout, guilt, and depression. The results point to recommending the incorporation of the evaluation of guilt as a symptom of burnout, in order to perform a more complete diagnosis and discriminate among subjects affected by burnout.

Biomarkers in burnout: a systematic review

BACKGROUND

Burnout is a stress state characterized by symptoms of mental exhaustion and physical fatigue, detachment from work, and feelings of diminished competence. Several biomarkers have been tested for association with burnout, but the results are conflicting.

AIM

The objective of this review was to identify potential biomarkers for burnout.

METHODS

We carried out a systematic review of studies comparing biomarkers in individuals with burnout and healthy controls, or individuals with low scores and those with high scores on burnout questionnaires. Literature searches in MEDLINE and EMBASE were performed. We describe biomarkers on which at least three studies were available. Where appropriate, a meta-analysis was carried out.

RESULTS

We identified 31 studies on 38 biomarkers involved in the hypothalamus-pituitary-adrenal axis, autonomic nervous system, immune system, metabolic processes, antioxidant defense, hormones, and sleep. At least 3 studies were available for cortisol in saliva and blood, blood pressure, heart rate, cholesterol, dehydroepiandrosterone sulfate, (numbers or activity of) natural killer cells, C-reactive protein, and prolactin. The comparability of studies was limited, due to differences in the methods used to characterize patients and controls, to assess biomarkers, and to control for confounders. Furthermore, burnout was operationalized in different ways. Meta-analyses showed no differences for cortisol awakening response and cortisol awakening response after administration of dexamethasone, cortisol in blood, and blood pressure.

CONCLUSIONS

No potential biomarkers for burnout were found, largely due to the incomparability of studies. We emphasize the need for a dimensional and longitudinal approach in future research to account for the heterogeneity of burnout.

Neurochemical and neuropharmacological aspects of circadian disruptions: an introduction to asynchronization

Circadian disruptions are common in modern society, and there is an urgent need for effective treatment strategies. According to standard diagnostic criteria, most adolescents showing both insomnia and daytime sleepiness are diagnosed as having behavioral-induced sleep efficiency syndrome resulting from insomnia due to inadequate sleep hygiene. However, a simple intervention of adequate sleep hygiene often fails to treat them. As a solution to this clinical problem, the present review first overviews the basic neurochemical and neuropharmachological aspects of sleep and circadian rhythm regulation, then explains several circadian disruptions from similar viewpoints, and finally introduces the clinical notion of asynchronization. Asynchronization is designated to explain the pathophysiology/pathogenesis of exhibition of both insomnia and hypersomnia in adolescents, which comprises disturbances in various aspects of biological rhythms. The major triggers for asynchronization are considered to be a combination of light exposure during the night, which disturbs the biological clock and decreases melatonin secretion, as well as a lack of light exposure in the morning, which prohibits normal synchronization of the biological clock to the 24-hour cycle of the earth and decreases the activity of serotonin. In the chronic phase of asynchronization, involvement of both wake- and sleep-promoting systems is suggested. Both conventional and alternative therapeutic approaches for potential treatment of asynchronization are suggested.

A newly proposed disease condition produced by light exposure during night: asynchronization

The bedtime of preschoolers/pupils/students in Japan has become progressively later with the result sleep duration has become progressively shorter. With these changes, more than half of the preschoolers/pupils/students in Japan recently have complained of daytime sleepiness, while approximately one quarter of junior and senior high school students in Japan reportedly suffer from insomnia. These preschoolers/pupils/students may be suffering from behaviorally induced insufficient sleep syndrome due to inadequate sleep hygiene. If this diagnosis is correct, they should be free from these complaints after obtaining sufficient sleep by avoiding inadequate sleep hygiene. However, such a therapeutic approach often fails. Although social factors are often involved in these sleep disturbances, a novel clinical notion--asynchronization--can further a deeper understanding of the pathophysiology of these disturbances. The essence of asynchronization is a disturbance in various aspects (e.g., cycle, amplitude, phase and interrelationship) of the biological rhythms that normally exhibit circadian oscillation, presumably involving decreased activity of the serotonergic system. The major trigger of asynchronization is hypothesized to be a combination of light exposure during the night and a lack of light exposure in the morning. In addition to basic principles of morning light and an avoidance of nocturnal light exposure, presumable potential therapeutic approaches for asynchronization involve both conventional ones (light therapy, medications (hypnotics, antidepressants, melatonin, vitamin B12), physical activation, chronotherapy) and alternative ones (kampo, pulse therapy, direct contact, control of the autonomic nervous system, respiration (qigong, tanden breathing), chewing, crawling). A morning-type behavioral preference is described in several of the traditional textbooks for good health. The author recommends a morning-type behavioral lifestyle as a way to reduce behavioral/emotional problems, and to lessen the likelihood of falling into asynchronization.

Mental fatigue: costs and benefits

A framework for mental fatigue is proposed, that involves an integrated evaluation of both expected rewards and energetical costs associated with continued performance. Adequate evaluation of predicted rewards and potential risks of actions is essential for successful adaptive behaviour. However, while both rewards and punishments can motivate to engage in activities, both types of motivated behaviour are associated with energetical costs. We will review findings that suggest that the nucleus accumbens, orbitofrontal cortex, amygdala, insula and anterior cingulate cortex are involved evaluating both the potential rewards associated with performing a task, as well as assessing the energetical demands involved in task performance. Behaviour will only proceed if this evaluation turns out favourably towards spending (additional) energy. We propose that this evaluation of predicted rewards and energetical costs is central to the phenomenon of mental fatigue: people will no longer be motivated to engage in task performance when energetical costs are perceived to outweigh predicted rewards.