Clinical Burnout Research Articles

Increased prevalence of burnout symptoms in parents of chronically ill children

To examine the prevalence of burnout symptoms in the context of parenting a chronically ill child. A total of 252 parents of children with Type 1 Diabetes Mellitus and 38 parents of children with Inflammatory Bowel Diseases participated in a population-based study. A control group consisted of 124 randomly selected parents of healthy children. We used self-report questionnaires to assess symptoms of burnout. The main finding was that significantly more parents of children with chronic diseases (36%) scored for clinical burnout, compared with parents of healthy children (20%). Burnout symptoms were most prominent among mothers of children with diabetes, although fathers of children with diabetes and mothers and fathers of children with inflammatory bowel diseases also reported higher levels of various burnout symptoms. Burnout may be a useful model for understanding long-term parental responses and should be acknowledged among the different types of psychological consequences of the multi-faceted experience of parenting a child with chronic illness. Gender seems to influence the risk of burnout symptoms. Continued research about other background factors, and how the parents' situation changes over time are warranted. In the clinic, we need to draw attention to the group of parents who may suffer from burnout.

Comparison of serum level of Brain-Derived Neurotrophic factor and Hypothalamus-Pituitary-Adrenal axis functioning in clinical burnout with controls

Comparison of serum level of Brain-Derived Neurotrophic factor and Hypothalamus-Pituitary-Adrenal axis functioning in clinical burnout with controls

Influence of sleep on symptom improvement and return to work in clinical burnout

The current study examined the extent to which symptom improvement and full return to work occurs among clinically burnt-out employees and what the influence of concurring sleep problems is with respect to health recovery. Fifty-nine burnt-out employees on extended sick leave assessed their symptoms for 2 weeks using an electronic diary. After 6 months, the measurements were repeated. Symptom levels were compared with those of a healthy reference group that was assessed only once. After 6 months, all burnout symptoms had decreased significantly, and full return to work was achieved by 37% of the burnt-out individuals. The symptom levels at 6 months of follow-up among those who had fully returned to work were similar to healthy levels and significantly lower than the levels of those still on sick leave. The persons who benefited poorly from sleep at baseline had higher exhaustion levels at follow-up than those who benefited from sleep. Trouble falling asleep and less refreshing sleep at baseline hampered eventual full work resumption. The results show that a significant number of clinically burnt-out employees is able to recover in a 6-month period and that sleep plays an important role both in symptom improvement and in return to work.

Evidence that impaired sleep recovery may complicate burnout improvement independently of depressive mood

Objective This article examines recovery through sleep in relation to sleep quality, exhaustion, and depression in clinical burnout. We focus on actual recovery per night, given its relevance to burnout improvement. Methods Sixty clinically burned-out participants and 40 healthy controls recorded symptoms with an electronic diary for 2 weeks at random times per day. Recovery through sleep was defined as the difference in fatigue between late evening and the next morning. Results In clinical burnout, sleep quality and recovery are impaired, and depression is elevated. Poor recovery through sleep is associated with poor same-night sleep quality, clarifying the mechanisms underlying poor recovery. Individual differences in recovery though sleep were related to differences in refreshed awakening, but not to other sleep problems. Impaired recovery was also related to severity of exhaustion, but not to severity of depressive mood, indicating that, in burnout, nonprofit from sleep is a symptom of energy depletion, not a sign of depression. Conclusion Impaired recovery through sleep may hamper recovery from burnout independently of the influence of depression.

Exhaustion and endocrine functioning in clinical burnout: An in-depth study using the experience sampling method

The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants completed the exhaustion subscale of the Maslach burnout inventory and kept an electronic diary for 2 weeks to assess momentary exhaustion and daily recovery through sleep. On 3 consecutive weekdays within the diary period, saliva was sampled to determine the cortisol awakening response (CAR), levels of dehydroepiandrosterone-sulphate (DHEAS) on the first 2 weekdays, and to conduct the dexamethasone suppression test (DST) on the third weekday. We found significant relationships between endocrine values and general momentary symptom severity as assessed with the diary, but not with the retrospective questionnaire-assessed burnout symptoms. Simultaneous assessments of endocrine values and burnout symptoms assessed with the diary after awakening rendered significant associations between persons, and a trend within persons. More severe burnout symptoms were consistently associated with a lower level and smaller increase of CAR, higher DHEAS levels, smaller cortisol/DHEAS ratios and a stronger suppression after DST. Burnout symptoms were significantly related to endocrine functioning in clinical burnout under the best possible conditions of symptom measurement. This adds support to the view that severity of burnout symptoms is associated with HPA-axis functioning.

Electronic diary evidence on energy erosion in clinical burnout.

Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion with those of healthy individuals. Sixty clinically burned-out and 40 healthy participants kept an electronic diary for 14 days, 7 times a day, yielding a total of 8,116 diary entries. This study shows that burned-out individuals typically suffer continuously from a severe fatigue throughout the day. The resulting flattened diurnal cycles mark a stable exhaustion that is uncommon in healthy persons. The current results provide novel support for the existence of severe energy erosion in clinical burnout.

Feasibility of an electronic diary in clinical burnout

Electronic diaries overcome important drawbacks of retrospective reports and capture fluctuations of psychological states and behavior. This study represents the first use of this method in clinically burned-out participants and aims to establish its feasibility concerning participant acceptability, compliance, and reactivity in this sample. Electronic diary measurement of burnout symptoms was performed 5 times a day for 2 weeks in 60 burned-out participants on sick leave and in 40 healthy controls. The method was well accepted, compliance was high (81%-96%), and no reactivity effect was found on the recording of burnout symptoms. We conclude that the electronic diary employed is accurate, reliable, and a promising tool in capturing key symptoms and their fluctuations in clinical burnout.

Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses

The aim of this study was to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK. The research instruments used were the Maslach Burnout Inventory and the Manchester Clinical Supervision Scale. At the time of the survey 817 community mental health nurses were reported to work within Wales. Two hundred and sixty (32%) community mental heath nurses working in 11 NHS Trusts responded to the survey. One hundred and eighty-nine (73%) community mental heath nurses had experience of clinical supervision in their present posts and 105 (40%) in their previous posts. The findings from the Maslach Burnout Inventory indicated high levels of emotional exhaustion for 36%, high levels of depersonalization for 12% and low levels of personal accomplishment for 10% of the community mental heath nurses surveyed. Univariate analysis showed that those community mental heath nurses who were younger, male and who had not experienced six or more sessions of clinical supervision were more likely to report cold negative attitudes towards their clients as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. One hundred and sixty-six community mental heath nurses had experienced six or more sessions of clinical supervision and had completed the Maslach Burnout Inventory. Higher scores on the Manchester Clinical Supervision Scale were also associated with lower levels of measured burnout, with significant negative correlations between the total Manchester Clinical Supervision Scale score and the emotional exhaustion subscale (r = -0.148, P = 0.050) and the depersonalization subscale (r = -0.220, P = 0.003) of the Maslach Burnout Inventory. These findings suggest that if clinical supervision is effective then community mental heath nurses are likely to report lower levels of emotional exhaustion and depersonalization. The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.

Cortisol deviations in people with burnout before and after psychotherapy: A pilot study.

Burnout is characterized by exhaustion, cynicism, and feelings of reduced competence. These complaints may be reflected in disturbances in the main stress regulatory endocrine system: the hypothalamus pituitary adrenal (HPA) axis. In this study, the HPA-axis hormone cortisol was sampled after awakening and during the day in 22 participants with clinical burnout and in 21 healthy controls. The cortisol level after awakening was shown to be significantly lower in the burnout group as compared with the control group. Cortisol levels during the day did not differ. The same sampling procedure was repeated after 14 sessions of psychotherapeutic intervention. The intervention led to a significant reduction in complaints and to an increase of the initially lowered morning cortisol levels. No consistent correlations, however, between the changes in subjective complaints and the change in cortisol parameters were found.

Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test

Burnout is presumed to be the result of chronic stress, and chronic stress is known to affect the HPA-axis. To date, studies on HPA-axis functioning in burnout have showed inconsistent results. In the present study, a large sample (n=74) of clinically diagnosed burnout individuals, mostly on sick-leave, were included and compared with 35 healthy controls. Salivary cortisol was sampled on 2 days to determine the cortisol awakening response (CAR) and the day-curve. In addition, the dexamethasone suppression test (DST) was applied to assess the feedback efficacy of the HPA-axis. There were no differences observed in the CAR, day-curve or CAR after DST in the burnout group as compared to a healthy control group. Burnout shows overlap in symptoms with chronic fatigue syndrome (CFS) and depression. Therefore, differential changes in HPA-axis functioning that resemble the hypo-functioning of the HPA-axis in CFS, or rather the hyper-functioning of the HPA-axis in depression, might have obscured the findings. However, no effect of fatigue or depressive mood on HPA-axis functioning was found in the burnout group. We concluded that HPA-axis functioning in clinically diagnosed burnout participants as tested in the present study, seems to be normal.

Psychometric properties of a Dutch version of the Maslach Burnout Inventory General Survey (MBI-DV) in individuals with and without clinical burnout

Psychometric properties of the Dutch version of the Maslach Burnout Inventory General Survey, the MBI-DV, were examined in individuals with and without clinical burnout. The factor structure, the utility of the MBI-DV as a screening instrument in addition to a clinical interview for diagnosing clinical burnout, as well as construct validity and reliability (internal consistency) were investigated. Individuals underwent a clinical interview and completed the MBI-DV as well as the Symptom Checklist (SCL-90). Confirmatory factor analysis, correlational analyses, and Cronbach alphas were computed and used to examine the objectives of the present study. A three-factor model of the MBI-DV best fitted the data in both individuals with and without clinical burnout. The Emotional Exhaustion subscale was highly associated with clinical diagnosis of burnout even when controlling for depression and general psychopathology. Construct validity of the MBI-DV was supported by modest correlations with the SCL-90 and subscales of the MBI-DV showed good internal consistency in individuals with and without clinical burnout. The MBI-DV is a valid and reliable multidimensional construct of which the Emotional Exhaustion subscale may be particularly useful as a screening tool in addition to a clinical interview for determining the presence of clinical burnout. Copyright © 2004 John Wiley & Sons, Ltd.

Cortisolontregeling bij werknemers met burnout; een pilotstudy

Cortisol disturbance in employees suffering burnout; a pilot study Cortisol disturbance in employees suffering burnout; a pilot study P. Mommersteeg, C. Heijnen, G. Keijsers, M. Verbraak & L. van Doornen, Gedrag & Organisatie, volume 17, February 2004, nr. 1, pp. 18-31. Burnout symptoms are the result of chronic job stress and insufficient recovery. Deviations in the secretion level of the stress hormone cortisol are associated with chronic stress and stress-related health problems. This study examined whether burnout subjects show a disturbed cortisol profile immediately after awakening, and whether a recovery of the deviating cortisol profile coincides with the relief of burnout symptoms after therapy. In this study the cortisol levels of both a clinical burnout group of employees (n=22) who were treated for their symptoms, and a matched control group (n=21) were determined, half an hour after awakening. The burnout group was sampled once more after 14 treatment sessions over approximately 6 months. At the initial measurement the burnout group showed lower cortisol levels after awakening in comparison to the control group. After treatment the burnout group reported fewer complaints whereas elevated levels of cortisol were found. Paradoxically, the rise in cortisol after therapy seems mainly attributable to subjects showing the least improvement in symptoms of exhaustion. Small sample size and the complexity and dynamics of this stress-response system complicate a clear interpretation of these findings.

Common infections and the role of burnout in a Dutch working population

Objective: To determine if burnout is a risk factor for common cold, flu-like illness and gastroenteritis. Methods: We conducted a prospective cohort study among 12,140 employees at baseline, using three consecutive self-administered questionnaires. The Maslach Burnout Inventory—General Survey (MBI-GS) was used to define employees with burnout complaints (Level 1) and clinical burnout (Level 2). The cross-sectional relationship between burnout and the occurrence of common infections was assessed at baseline, using logistic regression analysis. Survival analysis with Cox regression was performed to study the longitudinal relationship between burnout and the subscales of the MBI-GS as risk factors for common infections. Results: For both levels of burnout, an increased incidence of common infections was found at baseline. The largest effect was found for the relationship between burnout and gastroenteritis (OR: 1.86, CI: 1.57–2.21 for Level 1 and OR: 3.59, CI: 2.09–6.17 for Level 2). The longitudinal analyses showed comparable results, although less pronounced. The largest effect was again found for gastroenteritis (RR: 1.55, CI: 1.28–1.86 for Level 1 and RR: 2.09, CI: 1.09–3.98 for Level 2). For flu-like illness and common cold, we found smaller but significant effects at Level 1, but not at Level 2. The subscale “Exhaustion” was found to be the strongest predictor for infections at both levels of burnout. Conclusions: This study provides evidence for burnout as a risk factor for common infections in a large heterogeneous population. Taking into account that burnout or its subscales are not primary etiological agents for these common infections, the observed effects are large.

Notes on Psychiatry

<h3>Purpose:</h3> In primary care, clinical pharmacists often deliver a service called comprehensive medication management (CMM). While research has identified that CMM positively influences most aspects of the Quadruple Aim, it is unclear how CMM—both the service and the role of the pharmacist—may influence the primary care provider9s (PCP) clinical work, professional satisfaction, and burnout (described here as PCP9s work-life). We aimed to identify how PCPs perceive CMM impacts their work-life. <h3>Methods:</h3> Sixteen PCPs were interviewed. Interview questions centered on how CMM affects their work-life. After interviews were transcribed, a codebook was developed by 2 researchers and from the codes, themes were identified. <h3>Results:</h3> PCPs spoke of the pharmacist being an added skillset and resource and a collaborative partner in caring for patients. They also described 7 outcomes of having CMM available that contribute to their work-life. These outcomes were: decreased workload, satisfaction patients are receiving better care, reassurance, decreased mental exhaustion, enhanced professional learning, increased provider access, and achievement of quality measures. Lastly, the PCPs described barriers and areas of opportunity related to CMM. <h3>Conclusion:</h3> Our findings suggest PCPs believe CMM, in general, positively affects their work-life. CMM9s impact on PCPs aligns with many previously identified drivers of burnout and engagement among providers. These results shed light on how CMM may foster achievement of the Quadruple Aim.