Samuel Melamed

Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions.

Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, resulting from prolonged exposure to work-related stress. The authors review the accumulated evidence suggesting that burnout and the related concept of vital exhaustion are associated with increased risk of cardiovascular disease and cardiovascular-related events. The authors present evidence supporting several potential mechanisms linking burnout with ill health, including the metabolic syndrome, dysregulation of the hypothalamic-pituitary-adrenal axis along with sympathetic nervous system activation, sleep disturbances, systemic inflammation, impaired immunity functions, blood coagulation and fibrinolysis, and poor health behaviors. The association of burnout and vital exhaustion with these disease mediators suggests that their impact on health may be more extensive than currently indicated.

Chronic burnout, somatic arousal and elevated salivary cortisol levels.

Burnout syndrome, comprised of the symptoms of emotional exhaustion, physical fatigue, and cognitive weariness, is believed to be a result of ineffective coping with enduring stress. This study of 111 nonshift blue-collar workers free of cardiovascular disease (CVD) examined whether chronic burnout is associated with a state of somatic and physiological hyperarousal. Results showed that 37 workers exhibited symptoms of chronic burnout, with symptoms lasting at least 6 months. These workers, compared to those with no burnout symptoms (n = 52) or nonchronic burnout symptoms (n = 22), had higher levels of tension at work, postwork irritability, more sleep disturbances and complaints of waking up exhausted, and higher cortisol levels during the work day. These results suggest that chronic burnout is associated with heightened somatic arousal and elevated salivary cortisol levels. This may be part of the mechanism underlying the emerging association between burnout and risk of CVD.

Burnout and Risk Factors for Cardiovascular Diseases

The burnout syndrome denotes a constellation of physical fatigue, emotional exhaustion, and cognitive weariness resulting from chronic stress. Although it overlaps considerably with chronic fatigue as defined in internal medicine, its links with physical illness have not been systematically investigated. This exploratory study, conducted among 104 male workers free from cardiovascular disease (CVD), tested the association between burnout and two of its common concomitants--tension and listlessness--and cardiovascular risk factors. After ruling out five possible confounders (age, relative weight, smoking, alcohol use, and sports activity), the authors found that scores on burnout plus tension (tense-burnout) were associated with somatic complaints, cholesterol, glucose, triglycerides, uric acid, and, marginally, with ECG abnormalities. Workers scoring high on tense-burnout also had a significantly higher low density lipoprotein (LDL) level. Conversely, scores on burnout plus listlessness were significantly associated with glucose and negatively with diastolic blood pressure. The findings warrant further study of burnout as a predictor of cardiovascular morbidity and mortality.

The Association Between Burnout, Depression, Anxiety, and Inflammation Biomarkers: C-Reactive Protein and Fibrinogen in Men and Women

Following the demonstrated association of employee burnout or vital exhaustion with several risk factors for cardiovascular disease (CVD) and CVD risk, the authors investigated the possibility that one of the mechanisms linking burnout with CVD morbidity is microinflammation, gauged in this study by high-sensitivity C-reactive protein (hs-CRP) and fibrinogen concentrations. Their sample included 630 women and 933 men, all apparently healthy, who underwent periodic health examinations. The authors controlled for possible confounders including 2 other negative affective states: depression and anxiety. In women, burnout was positively associated with hs-CRP and fibrinogen concentrations, and anxiety was negatively associated with them. In men, depression was positively associated with hs-CRP and fibrinogen concentrations, but not with burnout or anxiety. Thus, burnout, depression, and anxiety are differentially associated with microinflammation biomarkers, dependent on gender.

Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons.

Objective: This prospective study was designed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout, a unique affective response to combined exposure to chronic stressors. Methods: The study participants were 677 employed men and women who were followed up for 3 to 5 years (mean = 3.6 years) for the onset of diagnosed type 2 diabetes. Burnout was assessed by the Shirom-Melamed Burnout Measure with its three subscales: emotional exhaustion, physical fatigue, and cognitive weariness. Results: The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status. During the follow-up period, 17 workers developed type 2 diabetes. Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes (95% confidence interval [CI] = 1.19–2.85) even after adjusting for age, sex, body mass index, smoking, alcohol use, leisure time physical activity, initial job category, and follow-up duration. In a subsample of 507 workers, the relative risk of diabetes was found to be much higher after additional control for blood pressure levels (odds ratio = 4.32, 95% CI = 1.75–10.67), available only for this subsample. Conclusions: These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals. CI = confidence interval; CVD = cardiovascular disease; SMBM = Shirom-Melamed Burnout Measure; HbA1c = glycosylated hemoglobin A1c; VE = vital exhaustion; MI = myocardial infarction; MBI = Maslach Burnout Inventory; BMI = body mass index; SBP = systolic blood pressure; DBP = diastolic blood pressure; OR = odds ratio; APR = acute phase response; CRP = C-reactive protein; HDL = high-density lipoprotein; HPA = hypothalamic–pituitary–adrenal.

Attenuating the impact of job demands: Additive and interactive effects of perceived control and social support☆

Abstract The study investigated the combined additive and interactive effects of psychosocial resources, perceived control (PC) and social support (SS), on psychological outcomes of job demands. Previous studies looked at their effects separately. The study adopted the expanded Job Demands-Control-Support (JD-CS) model. It addressed existing criticisms of many studies based on the original JD-C model, by using a broad spectrum measure of job demands, a more valid PC index, and modeling statistical interactions. The results among 267 female social workers indicate that PC and SS exert an additive effect in attenuating the impact of job demands. The lowest burnout level and the highest job satisfaction were found under conditions of low stress, i.e. low demands, high PC, and high SS. The opposite occurred under high stress, i.e., high demands, low PC, and low SS. As in most other studies of the JD-C or the JD-C-S models, no evidence of an interactive effect was found.

Effect of school age sports on leisure time physical activity in adults: The CORDIS Study.

PURPOSE Data evaluating the impact of various types of childhood physical activity on adult leisure time physical activity (LTPA) are inconsistent. The purpose of this study was to evaluate the influence of organized childhood sporting activities on LTPA as an adult in a cohort of industrial workers. METHODS The frequency of current LTPA, defined as a half hour or more of activity at least once per week, of 3687 industrial workers in the Cardiovascular Occupational Risk Factors in Israel Study (CORDIS) cohort was the outcome variable. We analyzed the association of organized school age sports with adult LTPA, using a multiple logistic regression model, after adjusting for sociodemographic variables including current occupational factors. RESULTS Participating in organized school age sporting activities predicted LTPA as an adult [adjusted odds ratio (OR) 3.55, 95% confidence intervals (95% CI) 2.97-4.23]. This association was consistent in the various subgroups of marital status, age, smoking, shift work, body mass index, and religious observance. CONCLUSIONS Organized school age sporting activities influenced future LTPA in this cohort. Attempts to promote these activities may lead to increased levels of LTPA in adults.

USEFULNESS OF THE PROTECTION MOTIVATION THEORY IN EXPLAINING HEARING PROTECTION DEVICE USE AMONG MALE INDUSTRIAL WORKERS

The present study examined the usefulness of personal variables: noise annoyance, and components of the protection motivation theory (R. W. Rogers, 1983) along with social-organizational factors in explaining hearing protection device (HPD) use among Israeli manufacturing workers. Participants were 281 men exposed to harmful noise levels for which routine HPD use is required by regulation. In practice, 3 HPD user groups were identified: nonusers (n = 38), occasional users (n = 125), and regular users (n = 118). HPD use was objectively verified. HPD use was primarily related to the personal variables but not to management pressure, coworker pressure, or family support. The most powerful predictors of HPD use were perceived self-efficacy (for long-term HPD use), perceived susceptibility (to hearing loss), and noise annoyance, together explaining 48% of the outcome variance. These findings have implications for interventions aimed at motivating workers to use HPDs regularly.

The joint effects of noise, job complexity, and gender on employee sickness absence: An exploratory study across 21 organizations — the CORDIS study

Using objective indicators, organizational archives, and expert ratings, we examined the joint effects of noise, job complexity and gender on employee sickness absence. The sample consisted of 802 white-collar employees across 21 organizations in Israel. We hypothesized that noise would have the strongest positive correlation with absenteeism for female employees with high job complexity. The results supported this hypothesis. Moreover, the full regression model (including the sets of covariates, main effects terms, and interaction terms) explained a meaningful portion (34%) of the absenteeism measure. Implications of the findings and suggestions for future studies are discussed.

The benefits of personality-leisure congruence: evidence and implications.

This study explores the beneficial effects of leisure congruence on well-being. Leisure congruence was defined as the degree of correspondence between an individuals personality type [using Hollan...