3. Burnout vs. Depression

Question 1

A three-dimensional syndrome made up of (emotional) exhaustion, cynicism (depersonalization), and lack of professional efficacy (reduced personal accomplishment) that develops in response to chronic occupational stress

Answer 1

Burnout

Question 2

Refers to the feelings of being emotionally drained and physically overextended; energy is lacking, and mood is low.

Answer 2

Exhaustion

Question 3

Characterizes a distant and callous attitude toward one’s job.

The individual is demotivated and withdraws from his/her work.

Answer 3

Cynicism

Question 4

Includes feelings of inadequacy and incompetence associated with loss of self-confidence.

Answer 4

Lack of professional efficacy

Question 5

Causes of burnout

Answer 5

A long-term mismatch between the demands associated with the job and the resources of the worker.

Prolonged, unresolvable stress at work that produces an enduring adaptative failure

Question 6

Biological marker of burnout

Answer 6

No biological marker has been found.

Burnout has increasingly been regarded as a hypocortisolemic disorder, consistent with the fact that cortisol reduces both normal and pathological fatigue.

Cortisol is the end product as well as a key effector of the neuroendocrine stress response.

Question 7

Questioning the burnout construct: Basic structure

Answer 7

Basic structure:

Unidimensional vs. multidimensional

Question 8

Questioning the burnout construct: Scope

Answer 8

Scope:

Work-related vs. cross-domain (or context-free)

Question 9

Questioning the burnout construct: Cardinal symptoms

Answer 9

Cardinal symptoms example:

As to whether cognitive impairment should be included

Question 10

Questioning the burnout construct: Course

Answer 10

Course example:

Onset, duration, offset, re-lapse

Question 11

Questioning the burnout construct: Distinctiveness

Answer 11

Distinctiveness:

With respect to depressive, anxiety, adjustment, and fatigue disorders.

NOTE: the level of fatigue and the appraisal of fatigue in burned out individuals do not differ from those reported in patients with major depression or anxiety disorders and may therefore not be relevant to the understanding of the specific pathological processes associated with burnout.

Question 12

Burnout consequences at occupational level

Answer 12

Absenteeism, presenteeism, poorer work performance, job turnover, and chronic work disability and disability pensions.

Question 13

Burnout consequences at a global level

Answer 13

Predicts severe injuries, insomnia, cases of coronary heart disease as well as hospitalization for mental and cardiovascular disorders.

Related to accelerated biological aging and all-cause mortality.

Question 14

Several authors have warned against the use of the burnout level in medical settings in the current context of diagnostic uncertainty because of a risk of leaving depressive episodes untreated, or of providing inappropriate treatment

Answer 14

The prevalence of burnout, strictly speaking, is unknown given the absence of consensually accepted diagnostic criteria

Question 15

Depression history

Answer 15

Deeply rooted in the history of medical science, its genesis can be traced back to Greek antiquity and Hippocrates’s theory of melancholic humor and continued through Galenic medicine and medieval times.

Question 16

Symptoms characterizing major depression

Answer 16

Depressed mood, anhedonia (loss of interest and pleasure), decreased or increased appetite and/or weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness and/or guilt, impaired concentration or decision making, and suicidal ideation.

Question 17

Shared etiology between burnout and depression

Answer 17

Unresolvable stress

Question 18

A key pathogenic factor in many theories of depression

Answer 18

The sustained impossibility of controlling one’s environment and actively neutralizing stressors

Question 19

A diagnosis of depression can be refined through

Answer 19

Subtype specification

Question 20

A distinction between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive.

Answer 20

1) It should be noted that the early stages of the depression process can be domain-specific (example: job-related). Therefore, “job-relatedness” is not discriminant.
2) Clinical burnout is pervasive in nature like clinical depression. The state associated with clinical burnout (overwhelming exhaustion) can impact the whole life of the affected individual (just like in clinical depression).
3) Attributing a given condition or disorder to a specific domain (work) does not change the nature of this condition or disorder.

Conclusion: a scope-based distinction is problematic.

Question 21

In a study, 90% of individuals with burnout met criteria for a provisional diagnosis of depression

Answer 21

Furthermore, no burned-out participant appeared to be free of depressive symptoms.

All of them had at least one depressive symptom.

Question 22

A circular causal relationship may exist between burnout and depression

Answer 22

Burnout may be a phase in the development of depression.

Also, depression may negatively influence the experience of work and generate burnout.

NOTE: These studies endorse the burnout-depression distinction rather than test it.

Question 23

Research dedicated to the embodiment of burnout has grown.

Answer 23

Burnout has been regarded as a product of chronic stress

The systems known to be altered in chronic stress (cardiovascular, immune and endocrine systems) have constituted objects of investigation.

Question 24

An attempt to distinguish burnout from depression was to associate burnout with hypocortisolism, and depression with hypercortisolism.

Answer 24

However, hypocortisolism may appear after a period of chronic, unresolvable stress as part of an organism’s response to the damaging effects of hypercortisolemia.

Question 25

Shares many features with burnout, including the tendency to be chronic and the centrality of fatigue symptoms.

Answer 25

Atypical depression

Question 26

Since there are many different subtypes of depression

Answer 26

Burnout should be compared to different subtypes, rather than unspecified sets of depressive symptoms.

Question 27

The MBI was used in more than 90% of the journal articles concerning burnout.

Answer 27

However, the MBI is neither grounded in firm clinical observation nor based on sound theorizing.

It has been developed inductively by factor-analyzing a rather arbitrary set of items.

One can reasonably wonder whether the initial definition of burnout has not been elected prematurely.

Systematic clinical observation may be indispensable to clearly identify the singularity (if any) of the burnout phenomenon and decide whether a new nosological category is needed.

Question 28

Conservative cutoff scores (corresponding to high frequencies of symptoms) should be used when interested in isolating cases of burnout.

Answer 28

In order to deal with the current lack of consensual diagnostic criteria for burnout, and to not generalize findings associated with the early stages of burnout to its late stages