3. Burnout vs. Depression Flashcards
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
Burnout
Refers to the feelings of being emotionally drained and physically overextended; energy is lacking, and mood is low.
Exhaustion
Characterizes a distant and callous attitude toward one’s job.
The individual is demotivated and withdraws from his/her work.
Cynicism
Includes feelings of inadequacy and incompetence associated with loss of self-confidence.
Lack of professional efficacy
Causes of burnout
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
Biological marker of burnout
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.
Questioning the burnout construct: Basic structure
Basic structure:
Unidimensional vs. multidimensional
Questioning the burnout construct: Scope
Scope:
Work-related vs. cross-domain (or context-free)
Questioning the burnout construct: Cardinal symptoms
Cardinal symptoms example:
As to whether cognitive impairment should be included
Questioning the burnout construct: Course
Course example:
Onset, duration, offset, re-lapse
Questioning the burnout construct: Distinctiveness
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.
Burnout consequences at occupational level
Absenteeism, presenteeism, poorer work performance, job turnover, and chronic work disability and disability pensions.
Burnout consequences at a global level
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.
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
The prevalence of burnout, strictly speaking, is unknown given the absence of consensually accepted diagnostic criteria
Depression history
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.
Symptoms characterizing major depression
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.
Shared etiology between burnout and depression
Unresolvable stress
A key pathogenic factor in many theories of depression
The sustained impossibility of controlling one’s environment and actively neutralizing stressors
A diagnosis of depression can be refined through
Subtype specification
A distinction between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive.
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.
In a study, 90% of individuals with burnout met criteria for a provisional diagnosis of depression
Furthermore, no burned-out participant appeared to be free of depressive symptoms.
All of them had at least one depressive symptom.
A circular causal relationship may exist between burnout and depression
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.
Research dedicated to the embodiment of burnout has grown.
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.
An attempt to distinguish burnout from depression was to associate burnout with hypocortisolism, and depression with hypercortisolism.
However, hypocortisolism may appear after a period of chronic, unresolvable stress as part of an organism’s response to the damaging effects of hypercortisolemia.
