Burnout or depression: both individual and social issue

Abstract

In view of the profound problems attached to the construct of burnout, we recommended in our Correspondence (April 8, p 1397)1Bianchi R Schonfeld IS Laurent E Physician burnout is better conceptualised as depression.Lancet. 2017; 389: 1397-1398Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar that occupational health specialists focus on (job-related) depression rather than burnout to help workers more effectively. In a reply to our letter, Ronald Epstein and Michael Privitera (April 8, 1398)2Epstein RM Privitera MR Physician burnout is better conceptualised as depression—Authors' reply.Lancet. 2017; 389: 1398Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar rejected our recommendation on the grounds that burnout is not a “purely individual syndrome”. The authors further argued that “considering burnout solely as a mental illness of individual workers rather than work-related distress would be disastrous”. Problematically, Epstein and Privitera attributed to us an idea that is not ours. In these authors' view, equating burnout with depression is synonymous with mistakenly individualising a social problem. In our estimation, the argument that depression cannot replace burnout because burnout is a social problem whereas depression is an individual problem is specious and part of a false debate. First, the phenomena of interest (burnout or depression) should not be confused with the perspectives (individual or social) adopted to elucidate those phenomena. Second, both burnout and depression are best explained through the interaction of social or external conditions with individual or internal dispositions.3Willner P Scheel-Krüger J Belzung C The neurobiology of depression and antidepressant action.Neurosci Biobehav Rev. 2013; 37: 2331-2371Crossref PubMed Scopus (342) Google Scholar, 4Bianchi R Schonfeld IS Vandel P Laurent E On the depressive nature of the “burnout syndrome”: a clarification.Eur Psychiatry. 2017; 41: 109-110Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar Unresolvable stress—the putative cause of burnout—has a key role in the aetiology of depression in individuals with no noticeable susceptibility to depression.3Willner P Scheel-Krüger J Belzung C The neurobiology of depression and antidepressant action.Neurosci Biobehav Rev. 2013; 37: 2331-2371Crossref PubMed Scopus (342) Google Scholar Crucially, in human beings, most sources of stress are rooted in social life (eg, work). Therefore, social factors are central to the development of depressive symptoms or disorders.4Bianchi R Schonfeld IS Vandel P Laurent E On the depressive nature of the “burnout syndrome”: a clarification.Eur Psychiatry. 2017; 41: 109-110Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar Depression can be job-related.4Bianchi R Schonfeld IS Vandel P Laurent E On the depressive nature of the “burnout syndrome”: a clarification.Eur Psychiatry. 2017; 41: 109-110Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 5Niedhammer I Malard L Chastang JF Occupational factors and subsequent major depressive and generalized anxiety disorders in the prospective French national SIP study.BMC Public Health. 2015; 15: 200Crossref PubMed Scopus (57) Google Scholar While leaving our recommendation intact, the authors' argument allows us to address an objection that is commonly raised when the burnout construct is questioned. We declare no competing interests. Physician burnout is better conceptualised as depressionRonald Epstein and Michael Privitera (Nov 5, p 2216)1 reported that burnout affects more than half of practising physicians. The authors additionally warned against confusing burnout with depression. We are concerned with the validity of these conclusions. Full-Text PDF Physician burnout is better conceptualised as depression – Authors' replyWe agree with Renzo Bianchi and colleagues that the public health significance of job-related distress is large—and costly in both human and financial terms1—and that the variability of definitions and thresholds for burnout in the literature have been problematic. West and colleagues' review in The Lancet2 addressed that issue partly by using one definition of burnout (high emotional exhaustion or depersonalisation) and also supplying data on individual domains and numerical Maslach burnout inventory scale scores. Full-Text PDF