Occupational burnout

Burnout affects teachers.

Relationship with other conditions

A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression.^{[112][113][114][115][116][117][118][109]} In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients.^[119] Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with very high scores on the MBI meet diagnostic criteria for depression.^[115] The view that burnout is a form of depression has found support in several recent studies.^{[104][113][114][116][117][118][99]} Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on burnout's diagnostic criteria.^[109][120] A newer generation of studies indicates that burnout, particularly its exhaustion dimension, problematically overlaps with depression; these studies have relied on more sophisticated statistical techniques, for example, exploratory structural equation modeling (ESEM) bifactor analysis, than earlier studies of the topic.^[121][104] The advantage of ESEM bifactor analysis, which combines the best features of exploratory and confirmatory factor analysis, is that it provides a granular look at item-construct relationships, without falling into traps earlier burnout researchers fell into.^[122]

Liu and van Liew^[57] wrote that "the term burnout is used so frequently that it has lost much of its original meaning. As originally used, burnout meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p. 434). The authors equate burnout with adjustment disorder with depressed mood.

Kakiashvili et al.,^[123] however, argued that although burnout and depression have overlapping symptoms, endocrine evidence suggests that the disorders' biological bases are different. They argued that antidepressants should not be used by people with burnout because the medications can make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse.

^{[123][131][132][133]}

Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression.^[134] The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in burnout.^[115] Commentators advanced the view that burnout differs from depression because the cortisol profile of burnout differs from that of melancholic depression; however, as the above table indicates, burnout's cortisol profile is similar to that of atypical depression.^[115]

According to a 2018 Gallup study, burned-out employees are at a 23% increased risk of going to the emergency room.[141]

Risk factors

Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role.^[142][143] Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout.^[144] One cause of burnout includes stressors that a person is unable to cope with fully.^[145] A 2019 survey by Cartridge People concluded that workload was the main cause of workplace stress.^[146]

Burnout is thought to occur when a mismatch is present between the nature of the job and the job the person is actually doing. A common indication of this mismatch is work overload, which sometimes involves a worker who survives a round of layoffs, but after the layoffs the worker finds that he or she is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organization's goals, but requires fewer employees to meet those goals.^[147] The research on downsizing, however, indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than mere burnout; these health effects include increased levels of sickness and greater risk of mortality.^[148]

The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI.^[149] Lack of job resources was associated with the disengagement component of the OLBI.

Maslach, Schaufeli and Leiter identified six risk factors for burnout in 2001: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.^[91]

Although job stress has long been viewed as the main determinant of burnout, recent meta-analytic findings indicate that job stress is a weak predictor of burnout.^[150] These findings question one of the most central assumptions of burnout research.

In a systematic literature review in 2014, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) found that a number of work environment factors could affect the risk of developing exhaustion disorder or depressive symptoms:

• People who experience a work situation with little opportunity to influence, in combination with too high demands, develop more depressive symptoms.
• People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others. Those who experience bullying or conflict in their work develop more depressive symptoms than others, but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder.
• People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others. This also applies to those who experience insecurity in the employment, for example concerns that the workplace will be closed down.
• In some work environments, people have less trouble. People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others.
• Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder.^[151]

The Stressmottagningen stress clinic believes "A certain type of person is considered to be at an increased risk of suffering from exhaustion disorder. The type includes creative, ambitious, perfectionist and emotionally committed individuals with a great need for appreciation, who find it difficult to delegate, find it difficult to say no to extra work and who find themselves in hierarchical organizations such as found in the healthcare, social care and education fields. Women aged between 35 and 50 are overrepresented in this category."^[152] Swedish worker health organisation Suntarbetsliv quoted statistics in 2017 showing that "women in their 30s are most affected."^[153]

The Gothenburg Institute of Stress Medicine's Kristina Glise wrote about a number of risk factors in February 2023.^[154]

Negative consequences of burnout on both the employee and the organization call for preventive measures in order to reduce the impact of the risk factors. Burnout prevention strategies, either addressing to the general working population (primary prevention) or the occupational groups which are more vulnerable (secondary prevention), are focused on reducing the impact of risk factors. Reviews of healthcare professionals‟ burnout focusing on identifying risk factors have been conducted previously.^[155]

A 2020 LinkedIn survey based on over 2.9 million responses concluded that employees struggling with work-life balance were 4.4 times more likely to show symptoms of occupational burnout.^[156]

Effects

The World Health Organisation has defined the effects of burnout as consisting of:

1. feelings of energy depletion or exhaustion
2. increased mental distance from one's job, or feelings of negativism or cynicism related to one's job
3. reduced professional efficacy.^[157]

This is in line with Christina Maslach and Susan E. Jackson's earlier findings that the syndrome is defined by emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment.^[1][39]

The Swedish health department has defined the effects of exhaustion disorder as being:

1. Concentration difficulties or impaired memory
2. Markedly reduced capacity to tolerate demands or to work under time pressure
3. Emotional instability or irritability
4. Sleep disturbance
5. Marked fatigability or physical weakness
6. Physical symptoms such as aches and pains, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sound.^[158]

A 2023 study by Elin Lindsäter et al. found a wide range of symptoms had by people formally diagnosed with exhaustion disorder. The most common symptoms reported by people currently suffering with the condition were tiredness (48%), lack of energy (41%), difficulty recovering from exertion (33%), poor general cognitive functioning (33%), memory issues (32%) and difficulty coping with perceived stressors and demands (31%).^[159]

Some research indicates that burnout is associated with reduced

There is research on dentists[113] and physicians^[99] that suggests that burnout is a depressive syndrome. Thus reduced job performance and cardiovascular risk could be related to burnout because of burnout's tie to depression. Behavioral signs of occupational burnout are demonstrated through cynicism within workplace relationships with coworkers, clients, and the organization itself.

Forced overtime, heavy workloads, and frenetic work paces give rise to debilitating repetitive stress injuries, on-the-job accidents, over-exposure to toxic substances, and other dangerous work conditions.^[163] Williams and Strasser suggested that healthcare workers have focused much attention on the workplace risk factors for heart disease and other illnesses, but have underemphasized work-related depression risk.^[164]

Other effects of burnout can manifest as lower energy and productivity levels, with workers observed to be consistently late for work and feeling a sense of dread upon arriving. They can suffer concentration problems, forgetfulness, increased frustration, and/or feelings of being overwhelmed. They may complain and feel negative, or feel apathetic and believe they have little impact on their coworkers and environment.^[162] Occupational burnout is also associated with absenteeism, other time missed from work, and thoughts of quitting.^[165]

Chronic burnout is also associated with cognitive impairments in memory and attention.^[166] (See also Effects of stress on memory.)

Studies by Agneta Sandström have shown that people diagnosed with exhaustion disorder had lower activity in the brain's frontal lobe than in control groups. They also had sleep problems caused by hormonal disturbances in the pituitary gland.^[167]

Research suggests that burnout can manifest differently between genders, with higher levels of depersonalisation among men and increased emotional exhaustion among women.^[168][169] Other research suggests that people revealing a history of occupational burnout face future hiring discrimination.^[170]

When it happens in the context of volunteering, burnout can often lead to volunteers significantly reducing their activities or stopping volunteering altogether.^[171] Likewise, academic stress, as it has been called, or academic burnout is a process originated from the inciting element, which implies the subjection to events that from the student's perspective can be considered as stressors.^[172]

Burnout might result in learned helplessness.^[81]

Burnout has been found to be associated with spiritual health.^[173]

Stages

Drozdstoj Stoyanov et al. believe burnout has three stages:

1. Flame out - trying to deal with excessive stress, causing depression and anxiety.
2. Genuine burn out - a process of increasing emotional exhaustion.
3. Rust out - being completely alienated from other people, cynical and ineffective.^[174]

A number of other researchers have also divided the burning-out process into stages.^[175]

Treatment and prevention

Health condition treatment and prevention methods are often classified as "primary prevention" (stopping the condition occurring), "secondary prevention" (removing the condition that has occurred) and "tertiary prevention" (helping people live with the condition).^[176]

Primary prevention

Maslach believes that the only way to truly prevent burnout is through a combination of organizational change and education for the individual.^[147]

Maslach and Leiter postulated that burnout occurs when there is a disconnection between the organization and the individual with regard to what they called the six areas of worklife: workload, control, reward, community, fairness, and values.^[91] Resolving these discrepancies requires integrated action on the part of both the individual and the organization.^[91] With regard to workload, assuring that a worker has adequate resources to meet demands as well as ensuring a satisfactory work–life balance could help revitalize employees' energy.^[91] With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment.^[91] Supportive leadership and relationships with colleagues are also helpful.^[91]

Hätinen et al. suggest "improving job-person fit by focusing attention on the relationship between the person and the job situation, rather than either of these in isolation, seems to be the most promising way of dealing with burnout."^[177] They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."^[177]

One approach for addressing these discrepancies focuses specifically on the fairness area. In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job.^[178] The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.^[91]

Barry A. Farber suggests strategies like setting more achievable goals, focusing on the value of the work, and finding better ways of doing the job, can all be helpful ways of helping the stressed. People who do not mind the stress but want more reward can benefit from reassessing their work–life balance and implementing stress reduction techniques like meditation and exercise. Others with low stress, but are underwhelmed and bored with work, can benefit from seeking greater challenge.^[179]

In addition to interventions that can address and improve conditions on the work side of work-life balance, the ways in which people spend their non-work time can help to prevent burnout and improve health and well-being.^[180]

Corporate Social Responsibility (CSR) initiatives are considered a resource which counteracts the stress effects of job demands, lowering employee burnout by boosting happiness, resilience and capitalizing altruism.^[181]

Establishing a sense of psychological safety (the belief that it is safe to speak up) in an organisation helps prevent burnout.^{[182][183][184][185]} Similarly, feeling heard may also help.^[182]

Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners.^[186]

Training employees in ways to manage stress in the workplace is effective in preventing burnout.^[187] One study suggests that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness, and hope may insulate individuals from experiencing occupational burnout.^[165] Increasing a worker's control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace.^[177]

Additional prevention methods include: starting the day with a relaxing ritual; yoga; adopting healthy eating, exercising, and sleeping habits; setting boundaries; taking breaks from technology; nourishing one's creative side, and learning how to manage stress.^{[188][189][190]}

In one trial, workers taking a high-dose Vitamin B complex "reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood after 12 weeks."^[191]

In another trial, doctors undertaking a program involving "mindfulness, reflection, shared experience, and small-group learning" for 9 months had a much lessened propensity to burn out.^[192] Another trial with medical interns found a ten-week mindfulness program reduced the incidence of burnout.^[193]

Burnout prevention programs have often focused on

CBT, relaxation techniques (including physical techniques and mental techniques), and schedule changes are the best-supported techniques for reducing or preventing burnout in a health-care setting.^{[citation needed]}

Work-related factors can also impact workers in their non-work time. Authors from the University of Utah found the increased incidence of boundary violations influenced reports of burnout in healthcare workers during the COVID-19 pandemic. The authors detailed specific patterns within the broader context of boundary violations whereby intrusion events are associated with increased job-related demands, and distancing events are associated with reduced job-related resources. In response, healthcare workers utilized specific boundary work tactics in response to specific types of boundary violations to redefine boundaries and forestall burnout.^[196]

A 2020 survey by FlexJobs and

Research in the fields of organisational psychology, group dynamics and team performance amongst others, have built a body of evidence around the role of psychological safety in the work place.^[200] Psychological safety is an interpersonal construct which is experienced at the team or group level. It is an environment where people feel comfortable sharing concerns and mistakes without fear of embarrassment or retribution.^[201] This safe environment enables inclusion and for team members to bring their full selves to work. Through this process, a broader variety of information is shared in the organisation, allowing for creativity, innovation and learning, but also providing a better basis on which to make decisions, in turn leading to better outcomes and performance. Engagement and satisfaction at work are also described outcomes of psychological safety, which in turn are seen to be protective against burn out.^[202][182]

Secondary and tertiary prevention (aka treatment and management)

Hätinen et al. list a number of common treatments, including

Salomonsson et al. found that for workers with exhaustion disorder, CBT was better than a Return to Work Intervention (RTW-I) for reducing stress; and that people whose symptoms were primarily depression, anxiety or insomnia had reduced total time away from work after a RTW-I than for CBT.[203] van Dam et al. had also earlier found that CBT was an effective treatment.^[204]

Ybe Meesters found that

Gordon Parker et al. found that the most useful treatment strategies appear to be talking to someone and seeking support, walking or other exercise, mindfulness and meditation, improving sleep, and leaving work completely or taking time off work.^[7][8]

The Swedish national health information service 1177 notes that "It is common for treatment and rehabilitation [of exhaustion disorder] to include several of the following parts:

• Information and education about how stress affects the body.
• Counseling and education on lifestyle and on methods to reduce daily stress. It can be done individually or in a group.
• Treatment with CBT.
• Conversation with a counsellor, psychologist or occupational therapist.
• Physiotherapy to work with the body in different ways.
• Medicines for sleep difficulties or depression."^[206]

The Royal Dutch College of General Practiconers recommends a three-stage treatment process, made up of a crisis phase, a problem and solution stage, and an application stage.^[72]

The Gothenburg regional government's Institute for Stress Medicine believes that "Recovery [from exhaustion disorder] is found in what is undemanding and joyful, and what that is varies greatly between individuals. Sleep and physical exercise are the basis of recovery and should be prioritized initially."^[207] According to a survey of their patients in 2018, the two most important drivers of recovery were "the sick leave itself" and "advice on physical activity."^[208] The institute's Kristina Glise (with others) has also twice detailed the institute's treatment practices in papers.^{[209][210][211]} Glise also wrote a series of diagnostic and treatment recommendations for doctors in February 2023.^[154]

The Stressmottagningen stress clinic believes that

The Swiss Expert Network on Burnout in 2016 recommended mindfulness training, physical exercise, nature therapy, whole-body cryotherapy and whole-body hyperthermia.^[213]

Swiss doctor Barbara Hochstrasser^[214] released a book containing her treatment recommendations in 2023.^[215]

Korczac et al. in a 2012 literature review found that "only for

Ahola et al. in a 2014 literature review found that less than 1% of 4430 papers reviewed contained scientifically rigorous data, and that the 14 well-designed studies collectively "showed that such [randomised control trial] interventions did not succeed in alleviating burnout symptoms."[217]

Grossi et al. in a 2015 literature review found that "cognitive impairments seen in clinical burnout are partially reversible through treatment, [typically CBT] but patients are still cognitively impaired at follow-up."^[65]

Perski et al. in a 2017 literature review found that "tertiary interventions for individuals with clinical burnout may be effective in facilitating RTW [return to work]. Successful interventions included advice from labor experts and enabled patients to initiate a workplace dialogue with their employers."^[218]

Wallensten et al. in 2019 literature review found that CBT and workplace dialogue were effective, and that treating sleep and cognitive function issues were also important.^[219]

Lindsäter et al. in a 2022 literature review note the reported success of CBT, acceptance and commitment therapy (ACT), a multimodal rehabilitation program (MMR) program (involving group CBT, applied relaxation in a group, individual

Burnout also often causes a decline in the ability to update information in working memory. This is not easily treated with CBT.[220]

One reason it is difficult to treat the three standard symptoms of burnout (exhaustion, cynicism, and inefficacy), is because they respond to the same preventive or treatment activities in different ways.^[177]

Exhaustion is more easily treated than cynicism and professional inefficacy, which tend to be more resistant to treatment. Research suggests that intervention actually may worsen the professional efficacy of a person who originally exhibited low professional efficacy.^[178]

Employee rehabilitation is a tertiary preventive intervention which means the strategies used in rehabilitation are meant to alleviate burnout symptoms in individuals who are already affected without curing them.^[177] Such rehabilitation of the working population includes multidisciplinary activities with the intent of maintaining and improving employees' working ability and ensuring a supply of skilled and capable labour in society.

A Communication Perspective

In a study conducted by Andrea Meluch,^[221] they studied how Communication Privacy Management can be applied to discussions about burnout across a diverse amount of sectors and industries. They found that discussing job burnout makes employees feel vulnerable and due to that feeling apply core and catalyst privacy rule criteria to help them make a decision about if they should disclose their job burnout. Core criteria is stable factors used to make choices about privacy rules while catalyst criteria refers to circumstantial influences that can cause a change in privacy rules. Meluch found the factors that contribute to if an employee discloses their feelings of burnout are if they feel that others in the company share the experience of burnout, the perceived judgment towards burnout, and the severity of the burnout they are feeling. Additionally the quality of the relationship they had and the level of trust they attributed to their coworkers and supervisors affected an employee's decision to disclose information. Meluch found that employees will conceal that they are burned out due to the level of risk and the worry about how they will be perceived in the workplace and how their work will be perceived.  

Another study by Debbie Dougherty and Kristina Drumheller^[222] explored how organizations manage the rationality/emotionality duality in the workplace. They found that in organizations that promote norms of rationality, organization members support the rationality/emotionality duality and accept and reinforce this duality by only focusing on emotions when they cause a disruption or rational practices and otherwise control their emotions. To privilege rationality over emotionality they usually recalled emotions in instances where their work was disrupted and rarely mentioned interpersonal conflict as emotional experiences. Additionally they would deny emotions, reframe emotions, rationally recite emotional experiences, and segment emotions “to a proper place and time”.^[222] Organizational members would rationalize their emotions and emotional expression as well as take emotions out of their sense making to fit the expectation of being rational. Dougherty and Drumheller expressed how only privileging rationality and not also privileging emotionality can inspire extreme emotional control that can lead to explosive forms of emotional expression such as organizational violence. They propose that organizational members need to be more aware of “the complex and necessary role of emotions”, promote healthy emotional expression, and recognize that organizations are locations of both emotional and rational sense making.

Katie Kim and Yeunjae Lee^[223] in their research on emotional exhaustion studied how emotional exhaustion is affected by organizations using transparent communication. They found when an employee feels emotionally exhausted, they have negative or cynical feelings towards their company and engage in negative communication behavior, such as complaining to external sources about their company. Kim and Lee express how this can affect organizations as their employees’ communication with external stakeholders can help with creating or losing an opportunity to build or maintain the organizations reputation. Employees can either share supportive views and Kim and Lee describe transparent communication as “an organization’s communication to make available all legally releasable information to employees whether positive or negative in nature”.^[223] It involves sustainability, accountability, and participation. Sustainability is the timely, accurate and unambiguous information provided to employees. Accountability is the organization's responsibility to provide objective and balanced information on activities and policies whether negative or positive. Participation is that stakeholders are involved in identifying the information that needs to be provided. Through this means of communication, Kim and Lee, found that transparent communication provides employees with the resources they feel they lack and creates a more positive relationship with the organization. Transparent communication helped alleviate emotional exhaustion and helped employees cope with burnout symptoms.

See also

Notes

References