The detection of psychiatric illness by questionnaire

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20311

Understanding the burnout experience: recent research and its implications for psychiatry.

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders in healthcare delivery must work together to develop and implement effective remedies for physician burnout.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/joim.12752

Physician burnout: contributors, consequences and solutions

Maslach Burnout Inventory Manual

Importance Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown Objective To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018 Data Extraction and Synthesis Burnout prevalence and study characteristics were extracted independently by 3 investigators Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate Therefore, studies were summarized descriptively and assessed qualitatively Main Outcomes and Measures Point or period prevalence of burnout assessed by questionnaire Results Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018 In all, 857% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 670% (122/182) on overall burnout, 720% (131/182) on emotional exhaustion, 681% (124/182) on depersonalization, and 632% (115/182) on low personal accomplishment Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively Overall burnout prevalence ranged from 0% to 805% Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 862%, 0% to 899%, and 0% to 871%, respectively Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined Conclusions and Relevance In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians

/pdf/prevalence-of-burnout-among-physicians-a-systematic-review-49qhu3lgv3.pdf

Prevalence of Burnout Among Physicians: A Systematic Review

https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1318&context=cc_pubs

Burnout-depression overlap: a review.

Objectives
The purpose of this study was to examine the overlap in burnout and depression.

Method
The sample comprised 1,386 schoolteachers (mean [M]age = 43; Myears taught = 15; 77% women) from 18 different U.S. states. We assessed burnout, using the Shirom-Melamed Burnout Measure, and depression, using the depression module of the Patient Health Questionnaire.

Results
Treated dimensionally, burnout and depressive symptoms were strongly correlated (.77; disattenuated correlation, .84). Burnout and depressive symptoms were similarly correlated with each of 3 stress-related factors, stressful life events, job adversity, and workplace support. In categorical analyses, 86% of the teachers identified as burned out met criteria for a provisional diagnosis of depression. Exploratory analyses revealed a link between burnout and anxiety.

Conclusions
This study provides evidence that past research has underestimated burnout–depression overlap. The state of burnout is likely to be a form of depression. Given the magnitude of burnout–depression overlap, treatments for depression may help workers identified as “burned out.”

/pdf/burnout-and-depression-two-entities-or-one-389mr9t6g7.pdf

Burnout and Depression: Two Entities or One?.

The link between burnout and depression remains unclear. In this study, we compared depressive symptoms in 46 burned-out workers, 46 outpatients experiencing a major depressive episode, and 453 burnout-free workers to test the distinctiveness of burnout as a clinical entity. Participants with burnout and major depressive episode reported similar, severe levels of overall depressive symptoms. The between-syndrome overlap was further verified for eight of the nine major depressive episode diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Our findings do not support the view hypothesizing that burnout and depression are separate entities and question the nosological added value of the burnout construct.

Comparative symptomatology of burnout and depression.

/pdf/is-burnout-a-depressive-disorder-a-reexamination-with-2cl1a46t4s.pdf

Is burnout a depressive disorder? A reexamination with special focus on atypical depression.

The “burnout syndrome” has been defined as a combination of emotional exhaustion, depersonalization, and reduced personal accomplishment caused by chronic occupational stress. Although there has been increasing medical interest in burnout over the last decades, it is argued in this paper that the syndrome cannot be elevated to the status of diagnostic category, based on (1) an analysis of the genesis of the burnout construct, (2) a review of the latest literature on burnout-depression overlap, (3) a questioning of the three-dimensional structure of the burnout syndrome, and (4) a critical examination of the notion that burnout is singularized by its job-related character. It turns out that the burnout construct is built on a fragile foundation, both from a clinical and a theoretical standpoint. The current state of science suggests that burnout is a form of depression rather than a differentiated type of pathology. The inclusion of burnout in future disorder classifications is therefore unwarranted. The focus of public health policies dedicated to the management of “burnout” should not be narrowed to the three definitional components of the syndrome but consider its depressive core.

/pdf/is-it-time-to-consider-the-burnout-syndrome-a-distinct-4fza9cg7xd.pdf

Renzo Bianchi

Papers

Burnout-depression overlap: a review.

Burnout and Depression: Two Entities or One?.

Comparative symptomatology of burnout and depression.

Is burnout a depressive disorder? A reexamination with special focus on atypical depression.

Is it time to consider the "burnout syndrome" a distinct illness?