Occupational burnout

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Occupational burn-out
Other namesBurn-out, exhaustion disorder, neurasthenia
Headache-1557872 960 720.jpg
A person who is experiencing psychological stress
SpecialtyPsychology Edit this on Wikidata
SymptomsEmotional exhaustion, depersonalization, reduced personal accomplishment,[1][2] fatigue[3]
Differential diagnosisMajor depressive disorder

According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy".[4] While burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition or mental disorder.[4] WHO additionally states that "Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."[4]


According to Wolfgang Kaskcha, "Burnout as a phenomenon has probably existed at all times and in all cultures."[5] He notes that the condition is described in the Book of Exodus (18:17–18).[5]

Gordon Parker believes the ancient European concept of acedia refers to burnout, and not depression as many others believe.[6][7]

It has been suggested that the first printed use of the term "burnout" in English was in one of Shakespeare's sonnets in 1599,[8] referring to a woman's love burning out. The sonnet in question is one of Shakespeare's most famous.

In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which was thought to be particularly found in "civilized, intellectual communities."[9] The concept soon became popular, and many in the United States believed themselves to have it. Some came to call it "Americanitis".[10] The rest cure was a commonly prescribed treatment (though there were many others). Beard yet further broadened the potential symptoms of neurasthenia over time, so that almost any symptom or behaviour could be deemed to be caused by it.[11] Don R Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful.[12]

In 1961, Graham Greene published the novel A Burnt-Out Case, the story of an architect who became greatly fatigued by his work, and who took much time to recover.[13]

In 1969, HB Bradley used the term "burnout" in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders.[14] This has been cited as the first known academic work to use the term for this concept.[8]

In 1974, Herbert Freudenberger, an American psychologist, used the term in his academic paper "Staff Burn-Out."[15] The paper was based on his qualitative observations of the volunteer staff (including himself) at a free clinic for drug addicts.[16] He characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands as well as physical symptoms such as headaches and sleeplessness, "quickness to anger", and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed." After the publication of Freudenberger's paper, interest in the concept grew.

In 1976, Christina Maslach noted the term being used by California lawyers working with the poor, and began to study the concept.[8]

In 1981, Maslach and Susan E. Jackson published an instrument for assessing burnout, the Maslach Burnout Inventory (MBI).[2] It was the first such instrument of its kind and the most widely used burnout instrument.[17] The two researchers described burnout in terms of emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment.[1][18]

In 2010, the Swedish Board of Health and Welfare adopted a refined conceptualisation of severe burnout it described as "exhaustion disorder."[19]

In 2015, The World Health Organization adopted a conceptualisation of burnout[20] that is consistent with Maslach's. It adopted a modified version of this in 2022. However, "is not itself classified by the WHO as a medical condition or mental disorder."[4]

Also in 2015, Bianchi and colleagues brought to bear evidence that the construct of burnout substantially overlaps with depression.[21]

As of 2017, nine European countries considered burnout as being a recognised medical disorder.[22]



The two main classification systems of psychological disorders are the Diagnostic and Statistical Manual of Mental Disorders (DSM, used in North America and elsewhere) from the American Psychiatric Association (APA), and the International Classification of Diseases (ICD, used in Europe and elsewhere) from the World Health Organisation (WHO).

Burnout is not recognized as a distinct mental disorder in the DSM-5 (published in 2013).[23] Its definitions for Adjustment Disorders,[24][25][26] and Unspecified Trauma- and Stressor-Related Disorder[27] in some cases reflect the condition. 2022's update, the DSM-5-TR, did not add a definition of burnout.[28]

As of 2017, nine European countries considered burnout as being a recognised medical disorder.[22] These countries classify it under one or more codes of the ICD.

The ICD-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code Z73.0.[29] It was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding".[30] It was also considered one of the "problems related to life-management difficulty".[31] The condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia.[32]

The ICD-10 also contained a medical condition category of "F43.8 Other reactions to severe stress."[33]

In 2010 the Swedish Board of Health and Welfare added “exhaustion disorder” (ED; F43.8A) to the Swedish version of the ICD-10, the ICD-10-SE, representing what is typically called "burnout" in English.[34][35] (See also sv:Utmattningssyndrom). Swedish sufferers of severe burnout had earlier been treated as having neurasthenia.[36]

The ICD-10-SE defined exhaustion disorder as consisting of:

A. Physical and mental symptoms of exhaustion during at least two weeks. The symptoms have developed in response to one or more identifiable stressors present for at least six months.

B. The clinical picture is dominated by markedly reduced mental energy, as manifested by reduced initiative, lack of endurance, or increased time needed for recovery after mental effort.

C. At least four of the following symptoms have been present, nearly every day, during the same 2-week period:

  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

D. The symptoms cause clinically significant distress or impairment in occupational, social or other important respects.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a physical illness/injury (e.g., hypothyroidism, diabetes, infectious disease).[19]

According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country."[37]

The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder[38] as part of the ICD-10 system. In the Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment.[36] A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practiconers were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.[39]

A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022.[40] The new version has an entry coded and titled "QD85 Burn-out". The ICD-11 describes the condition this way:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 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; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.[41]

This condition is classified under "Problems associated with employment or unemployment" in the section on "Factors influencing health status or contact with health services." The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services.[4][42] In a statement made in May 2019, the WHO said "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition."[43]

The ICD's browser and coding tool both attach the term "caregiver burnout" to category "QF27 Difficulty or need for assistance at home and no other household member able to render care."[44][45] QF27 thus acknowledges that burnout can occur outside the work context.

The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress",[46] which is the equivalent of the ICD-10's F43.8.

If, after treatment, a person with burnout continues to have persistent physical symptoms triggered by the condition, in Iceland they may be considered to have "somatic symptom disorder" (DSM-5) and "bodily distress disorder" (ICD-11).[47]

Further detail about the varied ways clinicians and others use ICD and DSM classification with burnout was published by Arno Van Dam in 2021.[48]

The US government's National Institutes of Health includes the condition as "psychological burnout" in its index of the National Library of Medicine,[49] and provides a number of synonyms. It defines the condition as "An excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure."[49]

SNOMED CT includes the term "burnout" as a synonym for its defined condition of "Physical AND emotional exhaustion state," which is a subtype of anxiety disorder.[50] The Diseases Database defines the condition as "professional burnout."[51]


In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory (MBI).[2] It remains by far the most commonly used instrument to assess the condition. Consistent with Maslach's conceptualization, the MBI operationalizes burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization (an unfeeling and impersonal response toward recipients of one's service, care, treatment, or instruction),[a] and reduced personal accomplishment.[1][2]

The MBI originally focused on human service professionals (e.g., teachers, social workers).[2] Since that time, the MBI has been used for a wider variety of workers (e.g., healthcare workers). The instrument or its variants are now employed with job incumbents working in many other occupations.[1]

There are other conceptualizations of burnout that differ from that suggested by Maslach and adopted by the WHO.

In 1999, Demerouti and Bakker, with their Oldenburg Burnout Inventory (OLBI), conceptualized burnout in terms of exhaustion and disengagement,[52] linking it to the job demands-resources model. This instrument is used mainly in the United States.

Also that year, Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale (UWES). It uses a similar conceptualisation to the MBI. However the UWES measures vigour, dedication and absorption; positive counterparts to the values measured by the MBI.[53] It is used mainly in Germany.

In 2005, TS Kristensen et al. released the public domain Copenhagen Burnout Inventory (CBI).[3] They argued that the definition of burnout should be limited to fatigue and exhaustion.[3] The CBI has had some use in Germany.

In 2006, Shirom and Melamed with their Shirom-Melamed Burnout Measure (SMBM) conceptualized burnout in terms of physical exhaustion, cognitive weariness, and emotional exhaustion.[54][55] An examination of the SMBM's emotional exhaustion subscale, however, indicates that the subscale more clearly embodies Maslach's[56] concept of depersonalization than her concept of emotional exhaustion.[17] This measure has seen little use.

In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index, a nine-item self-assessment tool designed to measure burnout and other dimensions of distress in healthcare workers specifically.[57] It has been mainly used in the United States.

In 2014, Aniella Besèr et al. developed the Karolinska Exhaustion Disorder Scale (KEDS),[19][58] which is used mainly in Sweden. It was designed to measure the symptoms defined by the ICD-10-SE's category for exhaustion disorder. The authors believed that those with the disorder were often initially depressed, but that this soon passed. The core symptoms of the disorder were deemed to be "exhaustion, cognitive problems, sleep disturbance". The authors also believed that the condition was clearly differentiated from both depression and anxiety.

In 2020, the Occupational Depression Inventory (ODI),[59] was developed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression.[60][61] The ODI covers nine symptoms, including exhaustion (burnout’s putative core). The instrument exhibits robust psychometric properties. The ODI is the only instrument that assesses work-related suicidal thoughts, a particularly important symptom calling for immediate attention. Available evidence indicates that burnout scales have very high correlations with the ODI, correlations that cannot be explained by item overlap,[60] suggesting that the ODI is a suitable replacement for burnout scales like the MBI.[62]

In 2021, the Sydney Burnout Measure (SBM) was released by Gordon Parker et al., which "captures domains of exhaustion, cognitive impairment, loss of empathy, withdrawal and insularity, and impaired work performance, as well as several anxiety, depression and irritability symptoms."[63]

There are still other conceptualizations as well that are embodied in other instruments, including the Hamburg Burnout Inventory,[64] and Malach-Pines's Burnout Measure.[65]

Kristensen et al.[3] and Malach-Pines (who also published as Pines)[66] advanced the view that burnout can also occur in connection to life outside of work. For example, Malach-Pines developed a burnout measure keyed the role of spouse.[67][68]

The core of all of these conceptualizations, including that of Freudenberger, is exhaustion.[56][69]

Maslach[56] advanced the idea that burnout should not be viewed as a depressive condition. Recent evidence, based on factor-analytic and meta-analytic findings, calls into question this supposition.[70][71][17] Burnout is also now often seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance).[72][73]

Marked differences among researchers' conceptualizations of what constitutes burnout have underlined the need for a consensus definition.[74][75]


In 1991, Barry A. Farber in his research on teachers proposed that there are three types of burnout:

  • "wearout" and "brown-out," where someone gives up having had too much stress and/or too little reward
  • "classic/frenetic burnout," where someone works harder and harder, trying to resolve the stressful situation and/or seek suitable reward for their work
  • "underchallenged burnout," where someone has low stress, but the work is unrewarding.

Farber found evidence that the most idealistic teachers who enter the profession are the most likely to suffer burnout.[76]

Caregiver burnout[edit]

Burnout affects caregivers.

Relationship with other conditions[edit]

A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression.[77][78][79][80][81][82][83][74] 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.[84] 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.[80] The view that burnout is a form of depression has found support in several recent studies.[69][78][79][81][82][83][64] 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.[74][85] 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.[86][69] 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.[87]

Liu and van Liew[26] 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.,[88] 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.

Test Major depressive disorder (typically melancholic depression) Atypical depression PTSD Chronic Fatigue Syndrome Burnout
Cortisol awakening response [88] [89] [88] [90][91] [88][92]
Adrenocorticotropic hormone (ACTH) [88] -[93] or ↓[92] - or ↓[88] - [94] - or ↓[88] or ↑[92]
Dehydroepiandrosterone sulphate (DHEA-S) [88] ↑ or ↓[88] [95] [88]
Low dose dexamethasone suppression test effect on cortisol no suppression[88] hypersuppression[88] hypersuppression[88]


Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression.[105] The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in burnout.[80] 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.[80]

It has previously been hypothesised that Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is caused by burnout.[106] It is suggested that the "burning out" of the body's stress symptom (by any of a wide range of causes) can lead to chronic fatigue. However, the very nomenclature of "Chronic Fatigue Syndrome" is viewed as problematic by both patients and healthcare professionals specialising in the condition, as it fails to encompass the wide range of non-fatigue related symptoms present in ME/CFS, or to differentiate between the so-named condition and the symptom of chronic fatigue which is present in many unrelated conditions or diseases. Furthermore, more up-to-date research has shown that ME/CFS is a multi-systemic condition that is not psychological in etiology and so comparison to occupational burnout is now less prudent.[107]

Overtraining syndrome is also known as "chronic fatigue," "burnout" and "overstress" in athletes.[108][109] It has been conceptualised as adjustment disorder, a common diagnosis for those burnt out.[110]

Recovering alcoholics often have a blunted cortisol response to stress,[111] as do some cancer patients and survivors.[112] This symptom is a particular feature of people suffering burnout. Altered cortisol response is experienced by up to 80% of people with depression.[113]

Risk factors[edit]

Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role.[114][115] Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout.[116] One cause of burnout includes stressors that a person is unable to cope with fully.[117]

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.[118] 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.[119]

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.[120] 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.[56]

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.[121] 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.[122]

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.[123]


Some research indicates that burnout is associated with reduced job performance,[124] coronary heart disease,[55] and mental health problems.[125] Examples of emotional symptoms of occupational burnout include a lack of interest in the work being done, a decrease in work performance levels, feelings of helplessness, and trouble sleeping.[126] With regard to mental health problems, research on dentists[78] and physicians[64] suggests that what is meant by 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.

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.[126] Occupational burnout is also associated with absenteeism, other time missed from work, and thoughts of quitting.[127]

Chronic burnout is also associated with cognitive impairments in memory and attention.[128] (See also Effects of stress on memory.)

Research suggests that burnout can manifest differently between genders, with higher levels of depersonalisation among men and increased emotional exhaustion among women.[129][130] Other research suggests that people revealing a history of occupational burnout face future hiring discrimination.[131]

When it happens in the context of volunteering, burnout can often lead to volunteers significantly reducing their activities or stopping volunteering altogether.[132] 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.[133]

Burnout might result in learned helplessness.[48]

Burnout has been found to be associated with spiritual health.[134]


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.[135]

Treatment and prevention[edit]

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).[136] 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.[137]

Primary prevention[edit]

Maslach believes that the only way to truly prevent burnout is through a combination of organizational change and education for the individual.[118]

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.[56] Resolving these discrepancies requires integrated action on the part of both the individual and the organization.[56] 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.[56] With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment.[56] Supportive leadership and relationships with colleagues are also helpful.[56]

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.[138] The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.[56]

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."[139] They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."

Burnout prevention programs have traditionally focused on cognitive-behavioral therapy (CBT),[140][141] cognitive restructuring, didactic stress management, and relaxation. 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. Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners.[142] Combining both organizational and individual-level activities may be the most beneficial approach to reducing symptoms. A Cochrane review, however, reported that evidence for the efficacy of CBT in healthcare workers is of low quality, indicating that it is no better than alternative interventions.[18]

For the purpose of preventing occupational burnout, various stress management interventions have been shown to help improve employee health and well-being in the workplace and lower stress levels. Training employees in ways to manage stress in the workplace have also been shown to be effective in preventing burnout.[143] 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.[127] 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.[139]

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.[144][145][146]

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 don't 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.[147]

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."[148]

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.[149] Another trial with medical interns found a ten-week mindfulness program reduced the incidence of burnout.[150]

Secondary and tertiary prevention (aka treatment and management)[edit]

Hätinen et al. list a number of common treatments, including treatment of any outstanding medical conditions, stress management, time management, depression treatment, psychotherapies, ergonomic improvement and other physiological and occupational therapy, physical exercise and relaxation. They have found that is more effective to have a greater focus on "group discussions on work related issues", and discussion about "work and private life interface" and other personal needs with psychologists and workplace representatives.[139]

Jac JL van der Klink and Frank JH van Dijk suggest stress inoculation training, cognitive restructuring, graded activity and "time contingency" (progressing based on a timeline rather than patient's comfort) are effective methods of treatment.[38]

Kakiashvili et al. said that "medical treatment of burnout is mostly symptomatic: it involves measures to prevent and treat the symptoms." They say the use of anxiolytics and sedatives to treat burnout related stress is effective, but does nothing to change the sources of stress. They say the poor sleep often caused by burnout (and the subsequent fatigue) is best treated with hypnotics and CBT (within which they include "sleep hygiene, education, relaxation training, stimulus control, and cognitive therapy"). They advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis dysfunction at the core of burnout. They also believe "vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction," noting the importance of specific nutrients. Omega-3 fatty acids may be helpful. DHA supplementation may also be useful for moderating norepinephrine. 11 beta-hydroxysteroid dehydrogenase (and potentially other metabolites of liquorice root extract) may help with lowered cortisol response.[88]

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.[151]

Ybe Meesters found that light therapy (similar to that used for Seasonal Affective Disorder) may be effective.[152]

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.[6][7]

Korczac et al. in a 2012 literature review found that "only for cognitive behavioural therapy (CBT) exists an adequate number of studies which prove its efficacy."[153]

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."[154]

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 psychotherapy, physiotherapy, lectures, and medical treatment), physical exercise, cognitive training, consuming rhodiola rosea extract, and participating in an African dance program. However, overall they noted that "a multitude of interventions have been investigated for exhaustion disorder, but the evidence for any one type of intervention is limited."[37]

Burnout also often causes a decline in the ability to update information in working memory. This is not easily treated with CBT.[155]

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.[139]

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.[138]

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.[139] 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.

See also[edit]

Stress and the workplace



  1. ^ The term "depersonalization" as used by Maslach and Jackson should not be confused with the same term used in psychiatry and clinical psychology as a hallmark of dissociative disorder.


  1. ^ a b c d Maslach C, Jackson SE, Leiter MP (1996). "MBI: The Maslach Burnout Inventory: Manual". Palo Alto: Consulting Psychologists Press.
  2. ^ a b c d e Maslach C, Jackson SE (1981). "The measurement of experienced burnout". Journal of Occupational Behavior. 2 (2): 99–113. doi:10.1002/job.4030020205. S2CID 53003646.
  3. ^ a b c d Kristensen TS, Borritz M, Villadsen E, Christensen KB (2005). "The Copenhagen Burnout Inventory: A new tool for the assessment of burnout". Work & Stress. 19 (3): 192–207. doi:10.1080/02678370500297720. S2CID 146576094.
  4. ^ a b c d e "Burn-out an "occupational phenomenon": International Classification of Diseases". WHO. 28 May 2019. Retrieved 2019-06-01.
  5. ^ a b Kaschka WP, Korczak D, Broich K (November 2011). "Burnout: a fashionable diagnosis". Deutsches Ärzteblatt International. 108 (46): 781–787. doi:10.3238/arztebl.2011.0781. PMC 3230825. PMID 22163259.
  6. ^ a b Parker, Gordon; Tavella, Gabriela; Eyers, Kerrie (2021-07-02). Burnout: A guide to identifying burnout and pathways to recovery. Allen & Unwin. ISBN 978-1-76106-214-8.
  7. ^ a b Parker, Gordon; Tavella, Gabriela (December 2021). "Burnout: modeling, measuring, and managing". Australasian Psychiatry. 29 (6): 625–627. doi:10.1177/10398562211037332. ISSN 1039-8562. PMID 34461751. S2CID 237365209.
  8. ^ a b c "Professional Burnout". Handbook of work and health psychology (PDF). Wiley. 1996. pp. 513–527.
  9. ^ Beard, George (1869-04-29). "Neurasthenia, or Nervous Exhaustion". The Boston Medical and Surgical Journal. 80 (13): 217–221. doi:10.1056/NEJM186904290801301. ISSN 0096-6762.
  10. ^ Marcus, G (1998-01-26). "One Step Back; Where Are the Elixirs of Yesteryear When We Hurt?". The New York Times. Retrieved 2008-09-11.
  11. ^ Beard, George Miller (1881). American Nervousness, Its Causes and Consequences: A Supplement to Nervous Exhaustion (neurasthenia). Putnam.
  12. ^ Lipsitt, Don R. (September 2019). "Is Today's 21st Century Burnout 19th Century's Neurasthenia?". The Journal of Nervous and Mental Disease. 207 (9): 773–777. doi:10.1097/NMD.0000000000001014. ISSN 0022-3018. PMID 31464987. S2CID 201667337.
  13. ^ Greene G (1961). A Burnt-Out Case. William Heinemann Ltd. pp. cover title. ISBN 978-0140185393.
  14. ^ Bradley HB (July 1969). "Community-based treatment for young adult offenders". Crime & Delinquency. 15 (3): 359–370. doi:10.1177/001112876901500307. S2CID 144032733.
  15. ^ Freudenberger HJ (January 1974). "Staff Burn-Out". Journal of Social Issues. 30 (1): 159–165. doi:10.1111/J.1540-4560.1974.TB00706.X.
  16. ^ Freudenberger HJ (1974). "Staff burnout". Journal of Social Issues. 30: 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
  17. ^ a b c Schonfeld IS, Verkuilen J, Bianchi R (December 2019). "Inquiry into the correlation between burnout and depression". Journal of Occupational Health Psychology. 24 (6): 603–616. doi:10.1037/ocp0000151. PMID 30945922. S2CID 92997542.
  18. ^ a b Ruotsalainen JH, Verbeek JH, Mariné A, Serra C (April 2015). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 2015 (4): CD002892. doi:10.1002/14651858.CD002892.pub5. PMC 6718215. PMID 25847433.
  19. ^ a b c Besèr, Aniella; Sorjonen, Kimmo; Wahlberg, Kristina; Peterson, Ulla; Nygren, Ake; Asberg, Marie (February 2014). "Construction and evaluation of a self rating scale for stress-induced exhaustion disorder, the Karolinska Exhaustion Disorder Scale". Scandinavian Journal of Psychology. 55 (1): 72–82. doi:10.1111/sjop.12088. ISSN 1467-9450. PMC 4235404. PMID 24236500.
  20. ^ "2022 ICD-10-CM Diagnosis Code Z73.0: Burn-out". www.icd10data.com. Retrieved 2022-07-15.
  21. ^ Bianchi, R., Schonfeld, I. S., & Laurent, E. (2015). Burnout-depression overlap: A review. Clinical Psychology Review, 36, 28–41. doi:10.1016/j.cpr.2015.01.004
  22. ^ a b Lastovkova A, Carder M, Rasmussen HM, Sjoberg L, Groene GJ, Sauni R, et al. (April 2018). "Burnout syndrome as an occupational disease in the European Union: an exploratory study". Industrial Health. 56 (2): 160–165. doi:10.2486/indhealth.2017-0132. PMC 5889935. PMID 29109358.
  23. ^ Vahia VN (July 2013). "Diagnostic and statistical manual of mental disorders 5: A quick glance". Indian Journal of Psychiatry. 55 (3): 220–223. doi:10.4103/0019-5545.117131. PMC 3777342. PMID 24082241.
  24. ^ Boudoukha AH, Hautekeete M, Abdellaoui S, Abdelaoui S, Groux W, Garay D (September 2011). "[Burnout and victimisation: impact of inmates' aggression towards prison guards]". L'Encéphale. 37 (4): 284–292. doi:10.1016/j.encep.2010.08.006. PMID 21981889. Burnout doesn't appear per se in any international classification of mental disorders: clinicians often use the diagnosis of adjustment disorder
  25. ^ Höschl C (January 2013). "2394 – Burnout is a myth". European Psychiatry. 28 (Supplement 1): 1. doi:10.1016/S0924-9338(13)77215-8. S2CID 144410795.
  26. ^ a b Liu PM, Van Liew DA (2003). "Depression and burnout.". In Kahn JP, Langlieb AM (eds.). Mental health and productivity in the workplace: A handbook for organizations and clinician. San Francisco: Jossey-Bass. pp. 433–457.
  27. ^ Association., American Psychiatric (2013). Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Publishing. p. 290. ISBN 978-0-89042-555-8. OCLC 926613691.
  28. ^ "Psychiatry.org - Updates to DSM-5 Criteria & Text". psychiatry.org. Retrieved 2022-07-14.
  29. ^ ICD-10: International Classification of Diseases, Z73. Geneva: World Health Organization, 2015.
  30. ^ "Chapter XXI: Factors influencing health status and contact with health services". International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2019.
  31. ^ "Z73 Problems related to life-management difficulty". International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2019.
  32. ^ "Z73 Burn-out". International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2019.
  33. ^ "F43.8 Other reactions to severe stress". International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2019.
  34. ^ Grossi G, Perski A, Osika W, Savic I (December 2015). "Stress-related exhaustion disorder--clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout". Scandinavian Journal of Psychology. 56 (6): 626–636. doi:10.1111/sjop.12251. PMID 26496458.
  35. ^ "Exhaustion syndrome". Mind. Retrieved 2022-07-14.
  36. ^ a b Schaufeli WB (June 2009). "Burnout: 35 years of research and practice". Career Development International. 14 (3): 204–220. doi:10.1108/13620430910966406. S2CID 47047482.
  37. ^ a b Lindsäter, Elin; Svärdman, Frank; Wallert, John; Ivanova, Ekaterina Nikolaevna; Söderholm, Anna; Fondberg, Robin; Nilsonne, Gustav; Cervenka, Simon; Lekander, Mats; Ruck, Christian (17 March 2022), Exhaustion Disorder: A Scoping Review of Research on a Recently Introduced Stress-Related Diagnosis (pdf) (Pre-print article), Center for Open Science, doi:10.31234/osf.io/m4w9x, retrieved 2022-07-14
  38. ^ a b van der Klink JJ, van Dijk FJ (December 2003). "Dutch practice guidelines for managing adjustment disorders in occupational and primary health care". Scandinavian Journal of Work, Environment & Health. 29 (6): 478–487. doi:10.5271/sjweh.756. JSTOR 40967326. PMID 14712856.
  39. ^ Ministerie van Volksgezondheid, Welzijn en Sport (2011-10-28). "Besluit van 30 september 2011, houdende wijziging van het Besluit zorgverzekering in verband met wijziging van de te verzekeren prestaties Zorgverzekeringswet per 2012 en de eigen bijdragen daarvoor en wijziging van dat besluit en het Besluit zorgaanspraken AWBZ in verband met stringent pakketbeheer en wijziging van het Besluit tegemoetkoming chronisch zieken en gehandicapten". zoek.officielebekendmakingen.nl (in Dutch). Retrieved 2022-07-14.
  40. ^ "WHO releases new International Classification of Diseases (ICD 11)".
  41. ^ "QD85 Burn-out". icd.who.int.
  42. ^ "24. Factors influencing health status or contact with health services". icd.who.int. Retrieved 2019-05-28. Categories in this chapter are provided for occasions when circumstances other than a disease, injury or external cause classifiable elsewhere are recorded as "diagnoses" or "problems." This can arise... When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. Such circumstance or problem may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as additional information to be borne in mind when the person is receiving care for some illness or injury.
  43. ^ "Burn-out an "occupational phenomenon": International Classification of Diseases". WHO.
  44. ^ "Need for assistance at home and no other household member able to render care". Archived from the original on 2014-08-08. Retrieved 2020-03-06.
  45. ^ "ICD-11 Coding Tool Mortality and Morbidity Statistics (MMS)". icd.who.int.
  46. ^ "ICD-11 - Mortality and Morbidity Statistics".
  47. ^ Broddadóttir, Elín; Flóvenz, Sigrún Ólafsdóttir; Gylfason, Haukur Freyr; Þormar, Þórey; Einarsson, Hjalti; Salkovskis, Paul; Sigurðsson, Jón Friðrik (2021-08-16). ""I'm So Tired": Fatigue as a Persistent Physical Symptom among Working People Experiencing Exhaustion Disorder". International Journal of Environmental Research and Public Health. 18 (16): 8657. doi:10.3390/ijerph18168657. ISSN 1661-7827. PMC 8392333. PMID 34444405.
  48. ^ a b van Dam A (2021-09-03). "A clinical perspective on burnout: diagnosis, classification, and treatment of clinical burnout". European Journal of Work and Organizational Psychology. 30 (5): 732–741. doi:10.1080/1359432X.2021.1948400. ISSN 1359-432X. S2CID 237829018.
  49. ^ a b "MeSH Browser". meshb.nlm.nih.gov. Retrieved 2022-07-14.
  50. ^ "58535001 - Physical AND emotional exhaustion state - SNOMED CT". www.findacode.com. Retrieved 2022-07-14.
  51. ^ Duncan, Malcolm (2022-05-04). "Professional burnout information Diseases Database". www.diseasesdatabase.com. Retrieved 2022-07-14.
  52. ^ Demerouti E, Bakker AB, Vardakou I, Kantas A (2003). "The convergent validity of two burnout instruments: A multitrait-multimethod analysis". European Journal of Psychological Assessment. 19: 12–23. doi:10.1027//1015-5759.19.1.12.
  53. ^ Schaufeli WB, Bakker A (November 2003). UWES-Utrecht work engagement scale. Preliminary manual (PDF). Occupational Health Psychology Unit Utrecht University. pp. 3–60.
  54. ^ Shirom A, Melamed S (2006). "A comparison of the construct validity of two burnout measures in two groups of professionals". International Journal of Stress Management. 13 (2): 176–200. doi:10.1037/1072-5245.13.2.176.,
  55. ^ a b Toker S, Melamed S, Berliner S, Zeltser D, Shapira I (October 2012). "Burnout and risk of coronary heart disease: a prospective study of 8838 employees". Psychosomatic Medicine. 74 (8): 840–847. doi:10.1097/PSY.0b013e31826c3174. PMID 23006431. S2CID 25632534.
  56. ^ a b c d e f g h i j Maslach C, Schaufeli WB, Leiter MP (2001). S. T. Fiske, D. L. Schacter, C. Zahn-Waxler (eds.). "Job burnout". Annual Review of Psychology. 52: 397–422. doi:10.1146/annurev.psych.52.1.397. PMID 11148311. S2CID 42874270.
  57. ^ Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD (January 2010). "Development and preliminary psychometric properties of a well-being index for medical students". BMC Medical Education. 10 (1): 8. doi:10.1186/1472-6920-10-8. PMC 2823603. PMID 20105312.
  58. ^ "K E D S - Karolinska Exhaustion Disorder Scale". www.kedsstresstest.com. Retrieved 2022-07-15.
  59. ^ Bianchi R, Schonfeld IS (November 2020). "The Occupational Depression Inventory: A new tool for clinicians and epidemiologists". Journal of Psychosomatic Research. 138: 110249. doi:10.1016/j.jpsychores.2020.110249. PMID 32977198. S2CID 221937871.
  60. ^ a b Schonfeld IS, Bianchi R (2022). "Distress in the workplace: Characterizing the relationship of burnout measures to the Occupational Depression Inventory". International Journal of Stress Management. 29 (3): 253–259. doi:10.1037/str0000261.
  61. ^ Schonfeld IS, Bianchi R (2021). "From burnout to occupational depression: Recent developments in research on job-related distress and occupational health". Frontiers in Public Health. 9: 796401. doi:10.3389/fpubh.2021.796401. PMC 8702721. PMID 34957039.
  62. ^ Schonfeld, I. S., & Bianchi, R. (2021). From burnout to occupational depression: Recent developments in research on job-related distress and occupational health. Frontiers in Public Health, 9(796401), 1-6. https://doi.org/10.3389/fpubh.2021.796401
  63. ^ Parker, Gordon; Tavella, Gabriela (October 2022). "Burnout: a case for its formal inclusion in classification systems". World Psychiatry. 21 (3): 467–468. doi:10.1002/wps.21025. ISSN 1723-8617. PMC 9453885. PMID 36073702.
  64. ^ a b c Wurm W, Vogel K, Holl A, Ebner C, Bayer D, Mörkl S, et al. (2016). "Depression-Burnout Overlap in Physicians". PLOS ONE. 11 (3): e0149913. Bibcode:2016PLoSO..1149913W. doi:10.1371/journal.pone.0149913. PMC 4773131. PMID 26930395.
  65. ^ Malach-Pines A (2005). "The Burnout Measure, Short Version". International Journal of Stress Management. 12 (1): 78–88. doi:10.1037/1072-5245.12.1.78.
  66. ^ Pines AM (1987). "Marriage burnout". Psychotherapy in Private Practice. 5: 31–44.
  67. ^ Pines AM (1996). Couple burnout. New York/London: Routledge.
  68. ^ Pines AM, Neal MB, Hammer LB, Icekson T (2011). "Job burnout and couple burnout in dual-earner couples in the sandwiched generation". Social Psychology Quarterly. 74 (4): 361–386. doi:10.1177/0190272511422452. S2CID 55657249.
  69. ^ a b c Schonfeld IS, Verkuilen J, Bianchi R (August 2019). "An exploratory structural equation modeling bi-factor analytic approach to uncovering what burnout, depression, and anxiety scales measure". Psychological Assessment. 31 (8): 1073–1079. doi:10.1037/pas0000721. PMID 30958024. S2CID 102348532.
  70. ^ Bianchi R, Verkuilen J, Schonfeld IS, Hakanen JJ, Jansson-Fröjmark M, Manzano-García G, et al. (March 2021). "Is burnout a depressive condition? A 14-sample meta-analytic and bifactor analytic study". Clinical Psychological Science. 24 (6): 603–616. doi:10.1177/2167702620979597. S2CID 233636338.
  71. ^ Bianchi R, Schonfeld IS, Verkuilen J (April 2020). "A five-sample confirmatory factor analytic study of burnout-depression overlap". Journal of Clinical Psychology. 76 (4): 801–821. doi:10.1002/jclp.22927. PMID 31926025. S2CID 210150400.
  72. ^ Bianchi R, Schonfeld IS, Laurent E (March 2015). "Burnout-depression overlap: a review". Clinical Psychology Review. 36: 28–41. doi:10.1016/j.cpr.2015.01.004. PMID 25638755.
  73. ^ Bianchi R, Schonfeld IS, Vandel P, Laurent E (March 2017). "On the depressive nature of the "burnout syndrome": A clarification". European Psychiatry. 41: 109–110. doi:10.1016/j.eurpsy.2016.10.008. PMID 28135592. S2CID 9411035.
  74. ^ a b c Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA (September 2018). "Prevalence of Burnout Among Physicians: A Systematic Review". JAMA. 320 (11): 1131–1150. doi:10.1001/jama.2018.12777. PMC 6233645. PMID 30326495.
  75. ^ Heinemann LV, Heinemann T (2017). "Burnout Research: Emergence and Scientific Investigation of a Contested Diagnosis". SAGE Open. 7: 215824401769715. doi:10.1177/2158244017697154.
  76. ^ Farber BA (1991). Crisis in education: stress and burnout in the American teacher. San Francisco: Jossey-Bass. ISBN 9781555422714.
  77. ^ Bianchi, E., Schonfeld, I.S., & Laurent, E. (2018). Burnout syndrome and depression. Y.-K. Kim (Ed.), Understanding depression: Volume 2. Clinical manifestations, diagnosis and treatment (pp.187-202). Singapore: Springer. doi:10.1007/978-981-10-6577-4_14
  78. ^ a b c Ahola K, Hakanen J, Perhoniemi R, Mutanen P (2014). "Relationship between burnout and depressive symptoms: A study using the person-centred approach". Burnout Research. 1 (1): 29–37. doi:10.1016/j.burn.2014.03.003.
  79. ^ a b Bianchi R, Laurent E (February 2015). "Emotional information processing in depression and burnout: an eye-tracking study". European Archives of Psychiatry and Clinical Neuroscience. 265 (1): 27–34. doi:10.1007/s00406-014-0549-x. PMID 25297694. S2CID 2891006.
  80. ^ a b c d Bianchi R, Schonfeld IS, Laurent E (2014). "Is burnout a depressive disorder? A re-examination with special focus on atypical depression". International Journal of Stress Management. 21 (4): 307–324. doi:10.1037/a0037906.
  81. ^ a b Bianchi R, Schonfeld IS, Laurent E (June 2015). "Is burnout separable from depression in cluster analysis? A longitudinal study". Social Psychiatry and Psychiatric Epidemiology. 50 (6): 1005–1011. doi:10.1007/s00127-014-0996-8. PMID 25527209. S2CID 10307296.
  82. ^ a b Hintsa T, Elovainio M, Jokela M, Ahola K, Virtanen M, Pirkola S (August 2016). "Is there an independent association between burnout and increased allostatic load? Testing the contribution of psychological distress and depression". Journal of Health Psychology. 21 (8): 1576–1586. doi:10.1177/1359105314559619. hdl:10138/224473. PMID 25476575. S2CID 206711913.
  83. ^ a b Schonfeld IS, Bianchi R (January 2016). "Burnout and Depression: Two Entities or One?". Journal of Clinical Psychology. 72 (1): 22–37. doi:10.1002/jclp.22229. PMID 26451877.
  84. ^ Bianchi R, Boffy C, Hingray C, Truchot D, Laurent E (June 2013). "Comparative symptomatology of burnout and depression". Journal of Health Psychology. 18 (6): 782–787. doi:10.1177/1359105313481079. PMID 23520355. S2CID 37998080.
  85. ^ Schwenk TL, Gold KJ (September 2018). "Physician Burnout-A Serious Symptom, But of What?". JAMA. 320 (11): 1109–1110. doi:10.1001/jama.2018.11703. PMID 30422283. S2CID 53293067.
  86. ^ Verkuilen J, Bianchi R, Schonfeld IS, Laurent E (September 2021). "Burnout-Depression Overlap: Exploratory Structural Equation Modeling Bifactor Analysis and Network Analysis". Assessment. 28 (6): 1583–1600. doi:10.1177/1073191120911095. PMID 32153199. S2CID 212651644.
  87. ^ Rodriguez A, Reise SP, Haviland MG (June 2016). "Evaluating bifactor models: Calculating and interpreting statistical indices". Psychological Methods. 21 (2): 137–150. doi:10.1037/met0000045. PMID 26523435.
  88. ^ a b c d e f g h i j k l m n o Kakiashvili T, Leszek J, Rutkowski K (June 2013). "The medical perspective on burnout". International Journal of Occupational Medicine and Environmental Health. 26 (3): 401–412. doi:10.2478/s13382-013-0093-3. PMID 24018996.
  89. ^ O'Keane V, Frodl T, Dinan TG (October 2012). "A review of Atypical depression in relation to the course of depression and changes in HPA axis organization". Psychoneuroendocrinology. 37 (10): 1589–1599. doi:10.1016/j.psyneuen.2012.03.009. PMID 22497986. S2CID 2372263.
  90. ^ Nater UM, Maloney E, Boneva RS, Gurbaxani BM, Lin JM, Jones JF, et al. (March 2008). "Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls". The Journal of Clinical Endocrinology and Metabolism. 93 (3): 703–709. doi:10.1210/jc.2007-1747. PMID 18160468.
  91. ^ Papadopoulos AS, Cleare AJ (September 2011). "Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome". Nature Reviews. Endocrinology. 8 (1): 22–32. doi:10.1038/nrendo.2011.153. PMID 21946893. S2CID 22176725.
  92. ^ a b c Moch SL, Panz VR, Joffe BI, Havlik I, Moch JD (August 2003). "Longitudinal changes in pituitary-adrenal hormones in South African women with burnout". Endocrine. 21 (3): 267–72. doi:10.1385/ENDO:21:3:267. PMID 14515012. S2CID 28957544.
  93. ^ Juruena MF, Bocharova M, Agustini B, Young AH (June 2018). "Atypical depression and non-atypical depression: Is HPA axis function a biomarker? A systematic review". Journal of Affective Disorders. 233: 45–67. doi:10.1016/j.jad.2017.09.052. PMID 29150144. S2CID 4678488.
  94. ^ Scott LV, Medbak S, Dinan TG (June 1998). "The low dose ACTH test in chronic fatigue syndrome and in health". Clinical Endocrinology. 48 (6): 733–737. doi:10.1046/j.1365-2265.1998.00418.x. PMID 9713562. S2CID 30486563.
  95. ^ Kuratsune H, Yamaguti K, Sawada M, Kodate S, Machii T, Kanakura Y, Kitani T (January 1998). "Dehydroepiandrosterone sulfate deficiency in chronic fatigue syndrome". International Journal of Molecular Medicine. 1 (1): 143–146. doi:10.3892/ijmm.1.1.143. PMID 9852212.
  96. ^ Mommersteeg PM, Heijnen CJ, Verbraak MJ, van Doornen LJ (February 2006). "Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test". Psychoneuroendocrinology. 31 (2): 216–225. doi:10.1016/j.psyneuen.2005.07.003. PMID 16150550. S2CID 8444094.
  97. ^ Sjörs A, Ljung T, Jonsdottir IH (10 July 2012). "Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion". BMJ Open. 2 (4): e001091. doi:10.1136/bmjopen-2012-001091. PMC 3400075. PMID 22786949.
  98. ^ de Vente W, van Amsterdam JG, Olff M, Kamphuis JH, Emmelkamp PM (October 2015). "Burnout Is Associated with Reduced Parasympathetic Activity and Reduced HPA Axis Responsiveness, Predominantly in Males". BioMed Research International. 2015: 431725. doi:10.1155/2015/431725. PMC 4628754. PMID 26557670.
  99. ^ Sonnentag S (October 2006). "Burnout and functioning of the hypothalamus-pituitary-adrenal axis--there are no simple answers". Scandinavian Journal of Work, Environment & Health. 32 (5): 333–337. doi:10.5271/sjweh.1028. PMID 17091200.
  100. ^ Oosterholt BG, Maes JH, Van der Linden D, Verbraak MJ, Kompier MA (May 2015). "Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout". Journal of Psychosomatic Research. 78 (5): 445–451. doi:10.1016/j.jpsychores.2014.11.003. PMID 25433974.
  101. ^ Onen Sertöz O, Binbay IT, Elbi Mete H (2008). "[The neurobiology of burnout: the hypothalamus-pituitary-adrenal gland axis and other findings]". Turk Psikiyatri Dergisi = Turkish Journal of Psychiatry. 19 (3): 318–328. PMID 18791885.
  102. ^ Verhaeghe J, Van Den Eede F, Van Den Ameele H, Sabbe BG (2012). "[Neuro-endocrine correlates of burnout]". Tijdschrift voor Psychiatrie. 54 (6): 517–526. PMID 22753184.
  103. ^ Ben-Zvi A, Vernon SD, Broderick G (January 2009). "Model-based therapeutic correction of hypothalamic-pituitary-adrenal axis dysfunction". PLOS Computational Biology. 5 (1): e1000273. Bibcode:2009PLSCB...5E0273B. doi:10.1371/journal.pcbi.1000273. PMC 2613527. PMID 19165314.
  104. ^ Karin O, Raz M, Tendler A, Bar A, Korem Kohanim Y, Milo T, Alon U (July 2020). "A new model for the HPA axis explains dysregulation of stress hormones on the timescale of weeks". Molecular Systems Biology. 16 (7): e9510. doi:10.15252/msb.20209510. PMC 7364861. PMID 32672906.
  105. ^ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
  106. ^ Van Houdenhove B, Van Den Eede F, Luyten P (June 2009). "Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system?". Medical Hypotheses. 72 (6): 701–705. doi:10.1016/j.mehy.2008.11.044. PMID 19237251.
  107. ^ "What is M.E.?".
  108. ^ Peluso MA, Guerra de Andrade LH (February 2005). "Physical activity and mental health: the association between exercise and mood". Clinics. 60 (1): 61–70. doi:10.1590/s1807-59322005000100012. PMID 15838583.
  109. ^ Carfagno DG, Hendrix JC (2014). "Overtraining syndrome in the athlete: current clinical practice". Current Sports Medicine Reports. 13 (1): 45–51. doi:10.1249/jsr.0000000000000027. PMID 24412891. S2CID 38361107.
  110. ^ Jones CM, Tenenbaum G (2009). "Adjustment Disorder: a new way of conceptualizing the overtraining syndrome". International Review of Sport and Exercise Psychology. 2 (2): 181–197. doi:10.1080/17509840903110962. S2CID 144679146.
  111. ^ Adinoff B, Junghanns K, Kiefer F, Krishnan-Sarin S (July 2005). "Suppression of the HPA axis stress-response: implications for relapse". Alcoholism: Clinical and Experimental Research. 29 (7): 1351–1355. doi:10.1097/01.ALC.0000176356.97620.84. PMC 2584966. PMID 16088999.
  112. ^ Bower JE, Ganz PA, Aziz N (March 2005). "Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue". Psychosomatic Medicine. 67 (2): 277–280. doi:10.1097/01.psy.0000155666.55034.c6. PMID 15784794. S2CID 12065356.
  113. ^ Thomson F, Craighead M (April 2008). "Innovative approaches for the treatment of depression: targeting the HPA axis". Neurochemical Research. 33 (4): 691–707. doi:10.1007/s11064-007-9518-3. PMID 17960478. S2CID 6522184.
  114. ^ Alarcon G, Eschleman KJ, Bowling NA (2009). "Relationships between personality variables and burnout: A meta-analysis". Work & Stress. 23 (3): 244–263. doi:10.1080/02678370903282600. S2CID 144848431.
  115. ^ Swider BW, Zimmerman RD (2010). "Born to burnout: A meta-analytic path model of personality, job burnout, and work outcomes". Journal of Vocational Behavior. 76 (3): 487–506. doi:10.1016/j.jvb.2010.01.003.
  116. ^ Bianchi R, Schonfeld IS (2016). "Burnout is associated with a depressive cognitive style". Personality and Individual Differences. 100: 1–5. doi:10.1016/j.paid.2016.01.008.
  117. ^ Mustafa OM (2015). "Health behaviors and personality in burnout: a third dimension". Medical Education Online. 20: 28187. doi:10.3402/meo.v20.28187. PMC 4568184. PMID 26365101.
  118. ^ a b Maslach C, Leiter MP (1997). The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. New York: Jossey-Bass.
  119. ^ Vahtera J, Kivimäki M, Pentti J, Linna A, Virtanen M, Virtanen P, Ferrie JE (March 2004). "Organisational downsizing, sickness absence, and mortality: 10-town prospective cohort study". BMJ. 328 (7439): 555. doi:10.1136/bmj.37972.496262.0d. PMC 381046. PMID 14980982.
  120. ^ Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB (June 2001). "The job demands-resources model of burnout". The Journal of Applied Psychology. 86 (3): 499–512. doi:10.1037/0021-9010.86.3.499. PMID 11419809.
  121. ^ Guthier C, Dormann C, Voelkle MC (December 2020). "Reciprocal effects between job stressors and burnout: A continuous time meta-analysis of longitudinal studies". Psychological Bulletin. 146 (12): 1146–1173. doi:10.1037/bul0000304. PMID 33119345. S2CID 226204886.
  122. ^ Services, Statens beredning för medicinsk och social utvärdering (SBU); Swedish Agency for Health Technology Assessment and Assessment of Social (2014-02-19). "Arbetsmiljöns betydelse för symtom på depression och utmattningssyndrom". www.sbu.se (in Swedish). Retrieved 2022-07-15.
  123. ^ Aydemir O, Icelli I (2013). "Burnout: Risk Factors". In Bährer-Kohler S (ed.). Burnout for Experts. Burnout for Experts: Prevention in the Context of Living and Working. Boston, MA: Springer US. pp. 119–143. doi:10.1007/978-1-4614-4391-9_8. ISBN 978-1-4614-4391-9.
  124. ^ Daniels, Alan H.; DePasse, J. Mason; Kamal, Robin N. (April 2016). "Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention". The Journal of the American Academy of Orthopaedic Surgeons. 24 (4): 213–219. doi:10.5435/JAAOS-D-15-00148. ISSN 1940-5480. PMID 26885712.
  125. ^ Gray, Patricia; Senabe, Sipho; Naicker, Nisha; Kgalamono, Spo; Yassi, Annalee; Spiegel, Jerry M. (2019-11-11). "Workplace-Based Organizational Interventions Promoting Mental Health and Happiness among Healthcare Workers: A Realist Review". International Journal of Environmental Research and Public Health. 16 (22): 4396. doi:10.3390/ijerph16224396. ISSN 1660-4601. PMC 6888154. PMID 31717906.
  126. ^ a b Aamodt M (2016). Industrial/organizational psychology : an applied approach (8th ed.). Boston, MA: Cengage Learning. p. 563. ISBN 978-1-305-11842-3.
  127. ^ a b Elliott TR, Shewchuk R, Hagglund K, Rybarczyk B, Harkins S (1996). "Occupational burnout, tolerance for stress, and coping among nurses in rehabilitation units". Rehabilitation Psychology. 41 (4): 267–284. doi:10.1037/0090-5550.41.4.267.
  128. ^ Sandström A, Rhodin IN, Lundberg M, Olsson T, Nyberg L (July 2005). "Impaired cognitive performance in patients with chronic burnout syndrome". Biological Psychology. 69 (3): 271–279. doi:10.1016/j.biopsycho.2004.08.003. PMID 15925030. S2CID 565283.
  129. ^ Houkes I, Winants Y, Twellaar M, Verdonk P (April 2011). "Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study". BMC Public Health. 11: 240. doi:10.1186/1471-2458-11-240. PMC 3101180. PMID 21501467.
  130. ^ Caufield M (8 November 2019). "Burnout: The Men's Health Crisis We Aren't Talking About". e-Surgery. Retrieved 2019-12-31.
  131. ^ Sterkens P, Baert S, Rooman C, Derous E (December 2021). "As If It Weren't Hard Enough Already: Breaking down Hiring Discrimination Following Burnout". Economics & Human Biology. IZA Discussion Papers. 43: 101050. doi:10.1016/j.ehb.2021.101050. PMID 34375926. S2CID 221135643. IZA DP No. 13514. Retrieved 14 May 2021.
  132. ^ Konieczny P (2018-01-01), "Volunteer Retention, Burnout and Dropout in Online Voluntary Organizations: Stress, Conflict and Retirement of Wikipedians", Research in Social Movements, Conflicts and Change, Research in Social Movements, Conflicts and Change, vol. 42, Emerald Publishing Limited, pp. 199–219, doi:10.1108/s0163-786x20180000042008, ISBN 978-1-78756-895-2, S2CID 155122668, retrieved 2021-04-29
  133. ^ Montoya-Restrepo, Iván Alonso; Rojas-Berrío, Sandra Patricia; Alexandra, Montoya-Restrepo Luz (23 March 2022). "Burnout Estudiantil Por COVID-19: Un estudio en universidades colombianas". Panorama (in Spanish). 16 (30). doi:10.15765/pnrm.v16i30.3131 (inactive 31 December 2022).{{cite journal}}: CS1 maint: DOI inactive as of December 2022 (link)
  134. ^ A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic; Ishbel Orla Whitehead, Suzanne Moffatt, Carol Jagger, Barbara Hanratty November 2, 2022 https://doi.org/10.1371/journal.pone.0276739
  135. ^ Stoyanov, Drozdstoj, ed. (2014-06-23). New Model of Burn Out Syndrome: Towards early diagnosis and prevention. River Publishers. p. 4. ISBN 978-87-93102-70-5.
  136. ^ "Primary, secondary and tertiary prevention". Institute for Work & Health, Toronto, Canada. Retrieved 4 August 2022.
  137. ^ Woolston, Chris (8 July 2022). "How to deal with work stress — and actually recover from burnout". Knowable Magazine. doi:10.1146/knowable-070722-1. Retrieved 4 August 2022.
  138. ^ a b Van Dierendonck D, Schaufeli WB, Buunk BP (1998). "The evaluation of an individual burnout intervention program: the role of in- equity and social support". J. Appl. Psychol. 83 (3): 392–407. doi:10.1037/0021-9010.83.3.392. S2CID 53132933.
  139. ^ a b c d e Hätinen M, Kinnunen U, Pekkonen M, Kalimo R (2007). "Comparing two burnout interventions: Perceived job control mediates decreases in burnout". International Journal of Stress Management. 14 (3): 227–248. doi:10.1037/1072-5245.14.3.227. S2CID 54520149.
  140. ^ Santoft, Fredrik; Salomonsson, Sigrid; Hesser, Hugo; Lindsäter, Elin; Ljótsson, Brjánn; Lekander, Mats; Kecklund, Göran; Öst, Lars-Göran; Hedman-Lagerlöf, Erik (May 2019). "Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout". Behavior Therapy. 50 (3): 475–488. doi:10.1016/j.beth.2018.08.005. ISSN 1878-1888. PMID 31030867. S2CID 139104080.
  141. ^ Richardson, Katherine M.; Rothstein, Hannah R. (2008). "Effects of occupational stress management intervention programs: A meta-analysis". Journal of Occupational Health Psychology. 13 (1): 69–93. doi:10.1037/1076-8998.13.1.69. ISSN 1939-1307. PMID 18211170.
  142. ^ Scheepers RA, Emke H, Epstein RM, Lombarts KM (February 2020). "The impact of mindfulness-based interventions on doctors' well-being and performance: A systematic review". Medical Education. 54 (2): 138–149. doi:10.1111/medu.14020. PMC 7003865. PMID 31868262.
  143. ^ McLaurine WD. A correlational study of job burnout and organizational commitment among correctional officers. Capella University. School of Psychology. p. 92. ISBN 9780549438144.
  144. ^ "Politically Active? 4 Tips for Incorporating Self-Care, US News". US News. 27 February 2017. Retrieved 5 March 2017.
  145. ^ Smith M, Segal R, Segal J (2014). "Stress Symptoms, Signs, & Causes: The Effects of Stress Overload and What You Can Do About It". Archived from the original on 27 September 2014. Retrieved 31 March 2014.
  146. ^ Grensman A, Acharya BD, Wändell P, Nilsson GH, Falkenberg T, Sundin Ö, Werner S (March 2018). "Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout". BMC Complementary and Alternative Medicine. 18 (1): 80. doi:10.1186/s12906-018-2141-9. PMC 5839058. PMID 29510704.
  147. ^ Farber BA (May 2000). "Treatment strategies for different types of teacher burnout". Journal of Clinical Psychology. 56 (5): 675–689. doi:10.1002/(SICI)1097-4679(200005)56:5<675::AID-JCLP8>3.0.CO;2-D. PMID 10852153.
  148. ^ Stough, Con; Scholey, Andrew; Lloyd, Jenny; Spong, Jo; Myers, Stephen; Downey, Luke A. (October 2011). "The effect of 90 day administration of a high dose vitamin B-complex on work stress". Human Psychopharmacology. 26 (7): 470–476. doi:10.1002/hup.1229. ISSN 1099-1077. PMID 21905094. S2CID 205924899.
  149. ^ West, Colin P.; Dyrbye, Liselotte N.; Rabatin, Jeff T.; Call, Tim G.; Davidson, John H.; Multari, Adamarie; Romanski, Susan A.; Hellyer, Joan M. Henriksen; Sloan, Jeff A.; Shanafelt, Tait D. (April 2014). "Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial". JAMA Internal Medicine. 174 (4): 527–533. doi:10.1001/jamainternmed.2013.14387. ISSN 2168-6114. PMID 24515493.
  150. ^ Ireland, Michael J.; Clough, Bonnie; Gill, Kim; Langan, Fleur; O'Connor, Angela; Spencer, Lyndall (April 2017). "A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners". Medical Teacher. 39 (4): 409–414. doi:10.1080/0142159X.2017.1294749. ISSN 1466-187X. PMID 28379084. S2CID 34659420.
  151. ^ Salomonsson, Sigrid; Santoft, Fredrik; Lindsäter, Elin; Ejeby, Kersti; Ingvar, Martin; Ljótsson, Brjánn; Öst, Lars‐Göran; Lekander, Mats; Hedman‐Lagerlöf, Erik (April 2020). "Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial". Scandinavian Journal of Psychology. 61 (2): 281–289. doi:10.1111/sjop.12590. ISSN 0036-5564. PMID 31691305. S2CID 207893892.
  152. ^ Meesters Y (February 2010). "Burnout and light treatment". Stress & Health. 26 (1): 13–20. doi:10.1002/smi.1250.
  153. ^ Korczak, Dieter; Wastian, Monika; Schneider, Michael (2012). "Therapy of the burnout syndrome". GMS Health Technology Assessment. 8: Doc05. doi:10.3205/hta000103. PMC 3434360. PMID 22984372.
  154. ^ Ahola, Kirsi; Toppinen-Tanner, Salla; Seppänen, Johanna (2017-03-01). "Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis". Burnout Research. 4: 1–11. doi:10.1016/j.burn.2017.02.001. ISSN 2213-0586.
  155. ^ Oosterholt BG, Van der Linden D, Maes JH, Verbraak MJ, Kompier MA (July 2012). "Burned out cognition--cognitive functioning of burnout patients before and after a period with psychological treatment". Scandinavian Journal of Work, Environment & Health. 38 (4): 358–369. doi:10.5271/sjweh.3256. JSTOR 41508903. PMID 22025205.

Further reading[edit]

  • Ahola K (2007-12-08). Occupational burnout and health (Report). University of Helsinki.
  • Caputo JS (1991). Stress and Burnout in Library Service. Phoenix, AZ: Oryx Press.
  • Cordes C, Dougherty T (1996). "A review and integration of research on job burnout". Academy of Management Review. 18 (4): 621–656. doi:10.5465/AMR.1993.9402210153.
  • Freudenberger HJ F (1974). "Staff burnout". Journal of Social Issues. 30: 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
  • Freudenberger HJ (1980). Burn-Out: The High Cost of High Achievement. Anchor Press.
  • Freudenberger HJ, North G (1985). Women's Burnout: How to Spot It, How to Reverse It, and How to Prevent It. Doubleday.
  • Maslach C, Leiter MP (May 2008). "Early predictors of job burnout and engagement". The Journal of Applied Psychology. 93 (3): 498–512. CiteSeerX doi:10.1037/0021-9010.93.3.498. PMID 18457483.
  • Ray B (2002). An assessment of burnout in academic librarians in America using the Maslach Burnout Inventory. New Brunswick, NJ: Rutgers University Press.
  • Shaw CS (1992). "A Scientific Solution To Librarian Burnout". New Library World. 93 (5). doi:10.1108/eum0000000002428.
  • Shirom A, Melamed S (2005). "Chapter 39: Does burnout affect physical health? A review of the evidence.". In Antoniou AS, Cooper CL (eds.). Research companion to organizational health psychology. Cheltenham, UK: Edward Elgar. pp. 599–622.
  • Wang Y, Ramos A, Wu H, Liu L, Yang X, Wang J, Wang L (July 2015). "Relationship between occupational stress and burnout among Chinese teachers: a cross-sectional survey in Liaoning, China". International Archives of Occupational and Environmental Health. 88 (5): 589–597. doi:10.1007/s00420-014-0987-9. PMID 25256806. S2CID 29960829.
  • Warr P (1999). Psychology at Work (4th ed.). London: Penguin.

External links[edit]