Romain Brisson

Is burnout solely job-related? A critical comment

Within the field-dominating, multidimensional theory of burnout, burnout is viewed as a work-specific condition. As a consequence, the burnout syndrome cannot be investigated outside of the occupational domain. In the present paper, this restrictive view of burnouts scope is criticized and a rationale to decide between a work-specific and a generic approach to burnout is presented. First, the idea that a multidimensional conception of burnout implies a work-restricted scope is deconstructed. Second, it is shown that the burnout phenomenon cannot be confined to work because chronic, unresolvable stress - the putative cause of burnout - is not limited to work. In support of an integrative view of health, it is concluded that the field-dominating, multidimensional theory of burnout should abandon as groundless the idea that burnout is a specifically job-related phenomenon and define burnout as a multi-domain syndrome. The shift from a work-specific to a generic approach would allow both finer analysis and wider synthesis in research on chronic stress and burnout.

Burnout and depression: Label-related stigma, help-seeking, and syndrome overlap

We investigated whether burnout and depression differed in terms of public stigma and help-seeking attitudes and behaviors. Secondarily, we examined the overlap of burnout and depressive symptoms. A total of 1046 French schoolteachers responded to an Internet survey in November-December 2015. The survey included measures of public stigma, help-seeking attitudes and behaviors, burnout and depressive symptoms, self-rated health, neuroticism, extraversion, history of anxiety or depressive disorder, social desirability, and socio-demographic variables. The burnout label appeared to be less stigmatizing than the depression label. In either case, however, fewer than 1% of the participants exhibited stigma scores signaling agreement with the proposed stigmatizing statements. Help-seeking attitudes and behaviors did not differ between burnout and depression. Participants considered burnout and depression similarly worth-treating. A huge overlap was observed between the self-report, time-standardized measures of burnout and depressive symptoms (disattenuated correlation: .91). The overlap was further evidenced in a confirmatory factor analysis. Thus, while burnout and depression as syndromes are unlikely to be distinct, how burnout and depression are socially represented may differ. To our knowledge, this study is the first to compare burnout- and depression-related stigma and help-seeking in the French context. Cross-national, multi-occupational studies examining different facets of stigma are needed.

Burnout and depression: Causal attributions and construct overlap

Burnout has been commonly regarded as a job-induced syndrome. In this 468-participant study (67% female; mean age: 46.48), we examined the extent to which individuals with burnout and depressive symptoms attribute these symptoms to their job. Fewer than half (44%) of the individuals with burnout symptoms viewed their job as the main cause of these symptoms. The proportion of participants ascribing their depressive symptoms to work was similar (39%). Results from correlation and cluster analyses were indicative of burnout–depression overlap. Our findings suggest that burnout may not be a specifically job-induced syndrome and further question the validity of the burnout construct.

Using Liberal Criteria to Identify Burnout Poses the Risk of Pathologizing Normal Adaptive States.

Academic Medicine, Vol. 90, No. 12 / December 2015 1584 Maslach, is to classify individuals as having symptoms of burnout if they have a high EE score along with either a high DP score or a low PA score. Either approach has trade-offs with respect to sensitivity and specificity. For example, using the high EE or high DP approach, 454/861 (52.7%) individuals in our sample would be classified as burned out; applying the EE plus either high DP or low PA approach, 254/850 (29.9 %) individuals would be classified as burned out. Respondents with burnout were more likely than those without burnout to agree/strongly agree with 8 of 10 perceived stigma items with the original criteria (high EE or high DP), and 7 of 10 items when the alternative criteria of burnout are applied. Those considered to be burned out under the original criteria but not burned out under the alternative criteria were also more likely than those without burnout to agree/strongly agree with 8 of 10 items, providing further evidence to support use of the original criteria.

Stranger Things: On the Upside Down World of Burnout Research

To the Editor: Strangely enough, diagnostic criteria for burnout failed to be established in more than 40 years of sustained research on the syndrome [1]. Arguably an even stranger phenomenon is the widespread tendency among burnout researchers to put the cart before the horse by trying to estimate the prevalence of a syndrome that cannot be formally diagnosed [1, 2]. Such attempts typically involve the use of arbitrary categorization criteria, cobbled together without any clear rationale. In the present letter, we discuss a recently published study by Holmes et al. [3] that, in our estimation, is symptomatic of this confusing trend. Holmes et al. [3] addressed the issue of burnout among residents of various medical specialties. Burnout was assessed with the emotional exhaustion and depersonalization subscales of the Maslach Burnout Inventory (MBI), a selfadministered questionnaire [4]. The authors found that 69 % of the surveyed residents suffered from burnout. Burnout rates ranged from 46 to 89 % among the medical specialties of interest. The authors additionally reported that directors of residency programs underestimated the prevalence of burnout among residents. From the authors’ viewpoint, the obtained results “clearly demonstrate that resident burnout is a highly prevalent problem.” We do not share such conclusions. In order to identify “residents with burnout,” Holmes et al. [3] used cut-off values available in the manual of the MBI [4]. Unfortunately, these cut-off values have been expressly indicated to be unsuited for diagnostic purposes (p. 9) [4]. Indeed, the cut-points in question reflect a mere tercile-based split and have no clinical or theoretical underpinning [2]. Furthermore, the authors allowed the respondents to be categorized as “burned out” based on their score on either the emotional exhaustion or the depersonalization subscale of the MBI. By doing so, the authors treated emotional exhaustion and depersonalization as two independent entities, rather than as the components of a unified syndrome—burnout. If, in the authors’ mind, emotional exhaustion and depersonalization represent separate entities that do not need to be studied in combination, the reason for grouping them under a single label, “burnout,” is arcane. The authors justified the use of their categorization criteria by a will to be “consistent with the literature.” However, the use of similar categorization criteria in past research does not change anything to their problematic character. The methods employed in past studies should be critically analyzed, rather than merely reused, if burnout research is to progress. Some investigators may argue that the use of the same categorization criteria from one study to another at least promotes between-study comparability. We do not think that comparing arbitrary estimates with other arbitrary estimates is a satisfactory investigation method. In view of the aforementioned problems, the authors’ observation that residency program directors underestimated the prevalence of burnout among residents loses its meaning. Indeed, for such an observation to be relevant, a valid * Renzo Bianchi renzo.bianchi@unine.ch

Distinction at the Class-Fraction Level? A Re-Examination of Bourdieu’s Dataset

This study examines the consistency of Pierre Bourdieu’s homology thesis by assessing, at a class-fraction level, the statistical significance of the differences in taste and lifestyle reported in Distinction. According to Bourdieu, taste and lifestyle vary not only from one social class to another, but also within social classes themselves, depending on the type of capital (notably, cultural or economic) that prevails among class fractions. In this article, we estimate the cultural distance separating eight fractions of the middle and upper classes by performing bilateral between-proportion comparison tests. Two levels of analysis are considered: the intra-class and the inter-class fraction levels. The first level only involves within-class comparisons. It aims to test the empirical basis of the concept of capital composition. The second level only involves comparisons between middle-class and upper-class fractions. It aims to test Bourdieu’s representation of social space. Results indicate that 1) the composition of capital is associated with taste variability in both the middle and upper classes, and 2) taste similarities and dissimilarities between fractions belonging to different classes are linked to cultural capital. In sum, this study provides additional evidence for the consistency of Bourdieu’s homology thesis.

La distinction : addendum statistique.

The aim of this study is twofold: first, to assess the statistical significance of the data used by Pierre Bourdieu in Distinction; second, to test the hypothesis that the volume of capital (i.e., the global amount of capital) allows for a finer discrimination of dispositional differences than the composition of capital (i.e., the respective weight of the different types of capital in the global amount of capital). To these ends, five data samples were submitted to bilateral between-proportion comparison tests. The findings (1) reveal that about two-thirds of the differences reported by P. Bourdieu are significant and (2) support the view that the volume of capital prevails over its composition.

Burnout: A Clinical and Sociological Reflection

Burnout: A Clinical and Sociological Reflection Gunderman [1] recently drew readers’ attention to six areas of work life [2] that may play a role in the development (and prevention) of job burnout among radiology staff: workload, control, reward, community, fairness, and values. Doing so, the author stressed the importance of clear diagnoses and sound classification schemes in (occupational) medicine: “Unless the appropriate diagnostic category is applied, further evaluation and treatment are likely to prove unproductive and may even cause harm, such as when a patientwith one type of disease is treated for another disease.” We salute Gunderman’s [1] efforts to promote occupational health in radiology units. We have, however, two concerns regarding the consistency of the author’s line of reasoning. First, although Gunderman [1] put great emphasis on the necessity for valid and reliable taxa in (occupational) medicine, he decided to focus on a syndrome, burnout, that is devoid of any binding or consensual diagnostic criteria [3,4]. The definitional and nosological blur surrounding burnout has long been pointed out by psychology and psychiatry researchers [4,5]. In parallel, the pathogenesis of burnout has been shown to be depressive in nature [5]. Given the well-documented overlap of burnout with (job-related) depression, and the fact that (job-related) depression is both diagnosable and treatable, a focus on (job-related) depression would have rendered the author’s line of argument more coherent. By relying on the burnout construct, the author seems to contravene his own prescriptions.

Chronic Occupational Stress Does Not Discriminate Burnout From Depression

Introduction It has been assumed that a key difference between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive. This view has recently been challenged at a theoretical level and additional empirical investigation has been called for. Objectives The aim of this study was to examine whether chronic occupational stress—the putative cause of burnout—discriminated burnout from depression. Following a scope-based approach to the burnout-depression distinction, chronic occupational stress should be primarily related to burnout and only to a lesser degree to depression. This hypothesis was tested. Methods A total of 2124 French teachers took part in this study (mean age: 41.36; 73% female) during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. The Effort-Reward Imbalance Questionnaire short form (ERIQ) was used for assessing chronic occupational stress. Results Burnout and depression were almost identically correlated to effort-reward imbalance at work. Interestingly, the job over-commitment component of the ERIQ was slightly more correlated to depression than to burnout. Multiple regression analyses showed that effort-reward imbalance at work and job over-commitment predicted depression as much as burnout, controlling for gender, age, and length of employment. Conclusions Chronic occupational stress was not found to discriminate burnout from depression. These results further question the relevance of a scope-based distinction between burnout and depression and supports the idea that burnout overlaps with depression.