Differentiating Burnout from Depression: Personality Matters!

Burnout among neurologists caring for patients with cognitive disorders in Spain

BACKGROUND

Physician burnout has a negative impact on both physicians and patients. Limited information is available on professional burnout of neurologists. The aim of this study was to assess the presence of burnout among neurologists caring for patients with cognitive disorders and to identify associated factors.

METHODS

An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists involved in the care of patients with cognitive disorders answered a survey composed of demographic characteristics, professional background, clinical practice setting, and behavioral factors. Burnout was assessed using a single-item measure from the Physician Work Life Study. A multivariate logistic regression analysis was conducted to determine the association between neurologists' characteristics and burnout.

RESULTS

A total of 188 neurologists answered the survey. The mean age (standard deviation-SD) was 40.6 (11.3) years and 52.7% were male. The majority of participants were general neurologists (60.6%) who attending a median of 20 patients with cognitive disorders (interquartile range 10.0-30.0) weekly. Thirty-nine participants (20.7%) reported burnout. Participants with burnout had greater experiences of regret associated with past clinical decisions than their counterparts (mean Regret Intensity Scale scores of 2.3 and 1.9, respectively; p = 0.003). Burnout was associated with non-academic practice (OR = 3.02 [95% CI 1.18, 7.73], p = 0.021) and care-related regret (OR = 2.53 [95% CI 1.13, 5.64], p = 0.023) in the multivariate analysis after adjustment for confounders.

CONCLUSIONS

Professional burnout was a common phenomenon among neurologists managing cognitive disorders. Identifying physician burnout and its associated factors may be critical for implementing preventive intervention strategies.

Burnout in surgeons: A qualitative investigation into contributors and potential solutions

BACKGROUND

Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions.

PURPOSE

This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work.

SETTING

Surgical departments in the United Kingdom's National Health Service (NHS).

MATERIALS

Telephone interview and face-to-face interview.

METHODS

This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout.

RESULTS

A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping.

CONCLUSION

Healthcare organisations, surgeons, and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.

Burnout among Iranian medical students: Prevalence and its relationship to personality dimensions and physical activity

Several studies have shown the association between personality traits and academic burnout. But the main goal of the present study was to find out an experimental answer to the following question: Does the relationship between personality dimensions and academic burnout is a simple relationship or physical activity can influence this relationship. In this cross-sectional correlational study, 417 medical students were selected from three major cities of Iran through stratified multistage sampling and assessed by demographic information form, Baecke Physical Activity Questionnaire, Temperament and Character Inventory, and Breso’s Academic Burnout Questionnaire. Bivariate Pearson correlations and hierarchical linear regression were used to examine the relationships between academic burnout, personality traits, and physical activity. In this study, 400 medical students (39% male and 61% female) filled the questionnaires correctly. The total prevalence of academic burnout was 25.5% (n=102), with heterogeneous levels. Regression analysis indicated that in a multivariate model, being male (β=0.08, p=0.013), higher years of medical school (β=0.18, p˂0.001), and lower scores in novelty seeking (β=-0.53, p=0.006), cooperativeness (β=-0.55, p=0.010), and physical activity (β=-1.22, p˂0.001) could be attributed to higher scores of academic burnout. Furthermore, physical activity had a moderating role in “novelty seeking-academic burnout” (β=-0.47, p=0.044) and “cooperativeness-academic burnout” (β=-0.89, p=0.001) relationships (∆R2=0.02, p˂0.001). The results suggested that male gender, higher years of medical school, and lower levels of novelty seeking, cooperativeness, and physical activity are associated with higher levels of academic burnout among Iranian medical students. Therefore, paying attention to male gender and individual difference factors, as well as planning for physical education classes during the medicine courses (especially in the last years of medical school), seems essential. However, more extensive investigations need to be carried out in this field through longitudinal studies.

Burnout among Iranian medical students: Prevalence and its relationship to personality dimensions and physical activity

Several studies have shown the association between personality traits and academic burnout. But the main goal of the present study was to find out an experimental answer to the following questions: Is there a simple relationship between personality dimensions and academic burnout? Can physical activity affect this relationship?. In this cross-sectional correlational study, 417 medical students were selected from three major cities of Iran through stratified multistage sampling and assessed by demographic information form, Baecke Physical Activity Questionnaire, Temperament and Character Inventory, and Breso's Academic Burnout Questionnaire. Bivariate Pearson correlations and hierarchical linear regression were used to examine the relationships between academic burnout, personality traits, and physical activity. In this study, 400 medical students (39% male and 61% female) filled the questionnaires correctly. The total prevalence of academic burnout was 25.5% (n=102), with heterogeneous levels. Regression analysis indicated that in a multivariate model, being male (β=0.08, p=0.013), higher years of medical school (β=0.18, p˂0.001), and lower scores in novelty seeking (β=-0.53, p=0.006), cooperativeness (β=-0.55, p=0.010), and physical activity (β=-1.22, p˂0.001) could be attributed to higher scores of academic burnout. Furthermore, physical activity had a moderating role in "novelty seeking-academic burnout" (β=-0.47, p=0.044) and "cooperativeness-academic burnout" (β=-0.89, p=0.001) relationships (ΔR2=0.02, p˂0.001). The results suggested that male gender, higher years of medical school, and lower levels of novelty seeking, cooperativeness, and physical activity are associated with higher levels of academic burnout among Iranian medical students. Therefore, paying attention to male gender and individual difference factors, as well as planning for physical education classes during the medicine courses (especially in the last years of medical school), seems essential. However, more extensive investigations need to be carried out in this field through longitudinal studies.

Effects of personality on the developmental trajectories of academic burnout among Korean medical students

Background

Medical students have a high risk of burnout from tremendous academic stress, and previous cross-sectional studies have explained this risk from the personality perspective. However, the relationship between complex personality profiles and developmental trajectory of burnout has not been delineated yet.

Methods

The longitudinal changes in burnout were measured by the Maslach Burnout Inventory-Student Survey (MBI-SS) at baseline (1st week), mid-term (9th week), and end-term (17th week), and personality was examined at baseline using the Temperament and Character Inventory (TCI). Latent trajectory groups based on the MBI-SS total scores were extracted using the General Growth Mixture Model (GGMM), and significant differences in personality profiles among the latent groups were identified using profile analysis and Analysis of Variance.

Results

Three burnout trajectory groups of high-increasing (HI), moderate-increasing (MI), and low-stable (LS) were identified, and these groups had significantly different TCI subscale profiles. The HI group had the highest score in Harm-Avoidance (HA) and lowest score in Self-Directedness (SD), and the MI group had a higher score in HA and lower scores in SD and Cooperativeness (CO) when compared to the LS group with the lowest score in HA and highest scores in SD and CO.

Conclusion

The current study showed that the HA, SD, and CO subscales of the TCI might explain the longitudinal development of academic burnout in medical students. Prevention of burnout and promotion of well-being in medical education concerning personality are discussed.

Resilience to Stress and Resilience to Pain: Lessons from Molecular Neurobiology and Genetics

What biological factors account for resilience to pain or to behavioral stress? Here, we discuss examples of cellular and molecular mechanisms within disparate parts of the nervous system as contributors to such resilience. In some especially well-studied humans, it is possible to identify particular neuronal cell types in the peripheral nervous system (PNS) and pinpoint specific genes that are major contributors to pain resilience. We also discuss more complex factors that operate within the central nervous system (CNS) to confer resilience to behavioral stress. We propose that genetic and neurobiological substrates for resilience are discoverable and suggest more generally that neurology and psychiatry hold lessons for each other as investigators search for actionable, biological underpinnings of disease.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Moderator Effects of Life Stress on the Association between MAOA-uVNTR, Depression, and Burnout

BACKGROUND

The serotonergic and noradrenergic systems have a strong impact on several affective disorders and are key targets for psychopharmacological therapy. With respect to pathogenesis, there is a growing body of evidence showing an influence of a promoter repeat polymorphism (MAOA-uVNTR) altering the expression rate of monoamine oxidase A. However, only a few studies investigate its influence on depression with only 2 of them considering the moderating effects of life stress. For burnout, there are no studies so far investigating the genetic basis.

OBJECTIVES

The aim of the present study was to replicate an interaction effect of MAOA-uVNTR and life stress on depression, and extend these possible findings to the burnout syndrome. Especially, the latter one might help in understanding the underlying mechanisms of burnout and its association to depression.

METHOD

A total of n = 1,541 participants (n = 1,099 healthy controls, n = 442 inpatients with affective disorders) provided genetic samples and filled in self-report questionnaires measuring depression, burnout, and the extent of experienced stressful life events (SLEs).

RESULTS

A life stress x MAOA-uVNTR interaction on depression and burnout was observed in women suggesting that carriers of the high expressing allele (MAO-H) with many SLEs had the highest scores in both burnout and depression. In men, there was only a weak effect of MAOA-uVNTR on depression.

CONCLUSIONS

The results suggest a more pronounced reactivity to adverse environmental factors in carriers of the MAO-H allele. Especially the effect of life stress and MAOA-uVNTR on burnout should be independently replicated in the future as this is the first study showing this association.

A study on the characteristics of Maslach Burnout Inventory-General Survey (MBI-GS) of workers in one electronics company

Background

This study investigated characteristics according to demographic, occupational factors of Maslach Burnout Inventory-General Survey (MBI-GS) and related scales to MBI-GS.

Methods

The subjects of the study were 3,331 workers in 3 different workplaces of one electronics company. They filled in demographic factors surveys, occupational factors surveys, MBI-GS, Korean Occupational Stress Scale-Short Form (KOSS-SF), Patient Health Questionnaire-9 (PHQ-9), and World Health Organization Quality Of Life-Abbreviated version (WHOQOL-BREF). The correlations between sub-scales of MBI-GS and KOSS-SF, PHQ-9, WHOQOL-BREF were analyzed respectively. And KOSS-SF, PHQ-9, and WHOQOL-BREF were categorized; mean scores of sub-scales of MBI-GS were compared; and the quartiles of sub-scales of MBI-GS were presented.

Results

A comparison of mean scores of MBI-GS according to demographic and occupational factors showed a significant difference according to age, problem drinking behavior, working time, and working duration in exhaustion regardless of sex. In professional efficacy, a significant difference was observed in age, marital status, working type, and working duration. And as a result of correlation analysis, the correlation coefficient between exhaustion and PHQ-9 was the highest regardless of sex. In addition, regardless of sex, exhaustion and cynicism scores tended to increase and professional efficacy score tended to decrease as the work stress level rose. Same tendency is shown in case of the more severe the symptom of depression and the lower quality of life. When the quartile for sub-scales' score of MBI-GS were investigated, the burnout was more pronounced in female than in male.

Conclusions

Many demographic and occupational factors affect burnout were identified in one electronics company, and we investigated which sub-scales of MBI-GS were affected. Through this study, burnout characteristics were identified in a few population group of Korea, and the results are expected to be useful for burnout risk group identification, counseling, etc.

Comparison of occupational burnout scores among medical residents and their correlation with dimensions of TCI questionnaire

Background: The present study was conducted to compare occupational burnout scores and determine their correlation with different dimensions of Temperament and Character Inventory (TCI) questionnaire among psychiatry, internal medicine, and surgery residents during the academic year 2013-14. Methods: In this cross sectional analytical study, 201 residents were recruited. Colinger's 125-item TCI and Maslach's Burnout Inventory were completed by residents. The mean severity of burnout and the mean scores in the subgroups of temperament and character were compared between the 3 groups of residents, and the correlations were calculated. Data were analyzed using SPSS software version 16. Also, A 2-sided p value of less than 0.05 was considered significant. Results: A significant positive correlation was found between severity of burnout and harm avoidance in internal medicine residents (r=0.7, p<0.001). Also, a significant correlation was found between severity of burnout and self-directedness in surgery residents (r=0.5, p=0.003), self-transcendence in internal medicine residents (r=0.04, p=0.009), and persistence in internal medicine (r=0.17, p=0.003) and surgery residents (r=0.10, p=0.004). A significant correlation was found between frequency of burnout and harm avoidance in internal medicine residents (r=0.6, p=0.001), self-directedness in surgery residents (r=0.9, p<0.001), persistence in surgery (r=0.14, p<0.001) and psychiatry residents (r=0.19, p<0.001), and finally self-transcendence in internal medicine residents (r=0.6, p<0.001). Conclusion: Dimensions of character were different among surgery, internal medicine, and psychiatry residents. Likewise, the severity of burnout was different among them according to personality traits. Occupational burnout appears to be less if personality traits match the chosen specialty.

Burnout and its relationship with perceived stress, self-efficacy, depression, social support, and programmatic factors in general surgery residents

BACKGROUND

Burnout affects surgical residents' well-being.

OBJECTIVE

We sought to identify factors associated with burnout among surgery residents.

METHODS

An electronic/anonymous survey was sent to surgical residents at 18 programs, consisting of demographic/programmatic questions and validated scales for burnout, depression, perceived stress, self-efficacy, and social support. Residents were grouped into quartiles based off burnout, and predictors were assessed using univariate and multivariate analyses.

RESULTS

42% of residents surveyed completed it. Burnout was associated with depression, higher perceived stress/debt, fewer weekends off, less programmatic social events, and residents were less likely to reconsider surgery if given the chance. Low burnout was associated with lower depression/stress, higher social support/self-efficacy, more weekends off per month, program mentorship, lower debt, and residents being more likely to choose surgery again if given the chance. On multivariate analysis, higher depression/perceived stress were associated with burnout, and lower burnout scores were associated with lower stress/higher self-efficacy.

CONCLUSIONS

Burnout in surgery residents is associated with higher levels of depression and perceived stress. The addition of programmatic social events, limiting weekend work, and formal mentoring programs may decrease burnout.

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

Background: Burnout is a psychological syndrome characterized by emotional exhaustion, feelings of cynicism and reduced personal accomplishment. In the past years there has been disagreement on whether burnout and depression are the same or different constructs, as they appear to share some common features (e.g., loss of interest and impaired concentration). However, the results so far are inconclusive and researchers disagree with regard to the degree to which we should expect such overlap. The aim of this systematic review and meta-analysis is to examine the relationship between burnout and depression. Additionally, given that burnout is the result of chronic stress and that working environments can often trigger anxious reactions, we also investigated the relationship between burnout and anxiety.

Method: We searched the online databases SCOPUS, Web of Science, MEDLINE (PubMed), and Google Scholar for studies examining the relationship between burnout and depression and burnout and anxiety, which were published between January 2007 and August 2018. Inclusion criteria were used for all studies and included both cross-sectional and longitudinal designs, published and unpublished research articles, full-text articles, articles written in the English language, studies that present the effects sizes of their findings and that used reliable research tools.

Results: Our results showed a significant association between burnout and depression (r = 0.520, SE = 0.012, 95% CI = 0.492, 0.547) and burnout and anxiety (r = 0.460, SE = 0.014, 95% CI = 0.421, 0.497). However, moderation analysis for both burnout–depression and burnout–anxiety relationships revealed that the studies in which either the MBI test was used or were rated as having better quality showed lower effect sizes.

Conclusions: Our research aims to clarify the relationship between burnout–depression and burnout–anxiety relationships. Our findings revealed no conclusive overlap between burnout and depression and burnout and anxiety, indicating that they are different and robust constructs. Future studies should focus on utilizing more longitudinal designs in order to assess the causal relationships between these variables.

Prevalence of burnout among German general practitioners: Comparison of physicians working in solo and group practices

Background

Studies from general practitioner (GP) populations from various European countries show a high prevalence of burnout, yet data from Germany are scarce and there are no data comparing GPs from solo versus group practices.

Methods

This cross-sectional survey addressed all GPs from a German network of family medicine practices comprising 185 practices. Participants were asked to fill in a self-administered questionnaire addressing socio-demographic and job-related characteristics. The German version of the Maslach Burnout Inventory was used to measure the dimensions emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each participant was categorized as having high EE, high DP and low PA following pre-defined cut-offs.

Results

A total of 214 GPs from 129 practices participated: 65.9% male, 24.8% solo practice. Of all GPs, 34.1% (n = 73) scored high for EE, 29.0% (n = 62) high for DP, 21.5% (n = 46) low for PA and 7.5% (n = 16) for all three dimensions. A higher risk for EE was found among female physicians, those unsatisfied with their job, those using few stress-regulating measures regularly and those reporting bad work-life balance. Burnout prevalence was higher in GPs in group than in solo practices (37.9% vs. 28.8% had high EE, 33.1% vs. 18.9% had high DP and 22.8% vs. 18.9% had low PA). A significantly higher prevalence of burnout symptoms was found in group practice employees compared to group practice owners.

Conclusion

Burnout prevalence was higher among physicians in group practices compared to solo practices. In group practices, employed, young, female and part-time working physicians showed a higher burnout risk.

Is Balint training associated with the reduced burnout among primary health care doctors?

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory - Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.

The effects of personality traits on academic burnout in Korean medical students

Background

Previous studies suggest that personality traits play an important role in academic burnout. The aim of this study was to investigate how Cloninger’s temperament and character traits explain academic burnout in a highly competitive environment of medical school.

Methods

A total of 184 Korean medical students participated in the survey. The Cloninger’s Temperament and Character Inventory was measured around the beginning of the semester and Maslach Burnout Inventory-Student Survey at the end of the semester. The correlations and stepwise regression analysis were conducted to explain the association between personality traits and academic burnout. In addition, latent profile analysis and profile analysis were employed to distinguish and explain differences of personality traits among latent academic burnout subgroups.

Results

The higher harm avoidance of temperament and lower self-directedness and cooperativeness of character predicted the subscales of academic burnout in medical students. The Temperament and Character Inventory personality profile of high, middle, and low latent burnout subgroups were significantly different.

Conclusion

This study showed that personality might account for the burnout level in medical education. The importance of character dimension for modulating the effects of temperament traits on academic burnout was discussed for future research.

Burnout and depression: Label-related stigma, help-seeking, and syndrome overlap

We investigated whether burnout and depression differed in terms of public stigma and help-seeking attitudes and behaviors. Secondarily, we examined the overlap of burnout and depressive symptoms. A total of 1046 French schoolteachers responded to an Internet survey in November-December 2015. The survey included measures of public stigma, help-seeking attitudes and behaviors, burnout and depressive symptoms, self-rated health, neuroticism, extraversion, history of anxiety or depressive disorder, social desirability, and socio-demographic variables. The burnout label appeared to be less stigmatizing than the depression label. In either case, however, fewer than 1% of the participants exhibited stigma scores signaling agreement with the proposed stigmatizing statements. Help-seeking attitudes and behaviors did not differ between burnout and depression. Participants considered burnout and depression similarly worth-treating. A huge overlap was observed between the self-report, time-standardized measures of burnout and depressive symptoms (disattenuated correlation: .91). The overlap was further evidenced in a confirmatory factor analysis. Thus, while burnout and depression as syndromes are unlikely to be distinct, how burnout and depression are socially represented may differ. To our knowledge, this study is the first to compare burnout- and depression-related stigma and help-seeking in the French context. Cross-national, multi-occupational studies examining different facets of stigma are needed.

Burnout among anaesthetists in Chinese hospitals: a multicentre, cross-sectional survey in 6 provinces

OBJECTIVES

Anesthesiology has reached a new stage which anaesthesia safety is significantly affected by human factors. The number of Chinese anaesthetists has increased to nearly twice as many as that in 2005. Attributed to traditional concepts, many problems in anesthesiology persist in Chinese hospitals. This study aims to determine the current status of anaesthesia job burnout, including problems related to burnout, as well as the conditions of anaesthesia human resources in Chinese hospitals.

METHODS

A multi-center, cross-sectional survey of 395 anaesthetists from 60 hospitals in 6 provinces was conducted to collect data on the work conditions of anesthesiologists by using questionnaires. The Maslach Burnout Inventory (MBI) was used to measure burnout. Different statistical models were also used to evaluate the data.

RESULTS

The number of Chinese anaesthetists has increased to nearly twice as many as that in 2005. According to our field survey of burnout among anaesthetists, only 17 (4.30%) respondents exhibited high levels of burnout. The average scores corresponding to the dimensions of burnout are 14.64 ± 11.40 (emotional exhaustion, EE), 4.22 ± 5.74 (depersonalization, DP), and 33.41 ± 10.05 (personal accomplishment, PA), as determined by MBI. These results indicate the differences in the spatial distribution of anaesthetists. Moreover, 15.3% of the anaesthetists showed high EE, 8.1% exhibited high DP, and 33.6% had low PA.

CONCLUSION

Anxiety and undesirable conditions experienced by professional groups in anaesthesiology need to be addressed. Educational level, an important factor in anaesthesia care, influences not only psychological health of practitioners but patient safety as well. Thus, personnel structure must be optimized to relieve tension in the practice of the profession and reduce burnout among anaesthetists in hospitals in China. Meanwhile, the management must increase its effort toward improving the mental health of practitioners and patient safety in anaesthesia care.