Case 5 depression and burnout
1. What is depression vs. burnout?
Article Bianchi
- The current state of the art suggests that the distinction between burnout and
depression is conceptually fragile. It is notably unclear how the state of burnout (i.e.,
the end stage of the burnout process) is conceived to differ from clinical depression.
Empirically, evidence for the distinctiveness of the burnout phenomenon has been
inconsistent, with the most recent studies casting doubt on that distinctiveness. The
absence of consensual diagnostic criteria for burnout and burnout research's
insufficient consideration of the heterogeneity of depressive disorders constitute major
obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the
seminal, field-dominating definition of burnout is questioned. It is suggested that
systematic clinical observation should be given a central place in future research on
burnout–depression overlap.
- burnout is a three-dimensional syndrome made up of (emotional) exhaustion, cynicism
(also termed depersonalization), and lack of professional efficacy (or reduced personal
accomplishment) that develops in response to chronic occupational stress. Exhaustion
refers to the feelings of being emotionally drained and physically overextended;
energy is lacking and mood is low. Cynicism characterizes a distant and callous
attitude toward one's job; the individual is de-motivated and withdraws from his/her
work. Lastly, lack of professional efficacy includes feelings of inadequacy and
incompetence associated with loss of self-confidence. The main conceptions of
burnout share the general idea that burnout is the result of prolonged, unresolvable
stress at work or, put differently, that burnout is caused by a long-term mismatch
between the demands associated with the job and the resources of the worker. no
binding diagnostic criteria are available for identifying cases of burnout
- the DSM-5 lists nine main symptoms characterizing major depression: Depressed
mood, anhedonia (loss of interest and pleasure), decreased or increased appetite and/or
weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss
of energy, feelings of worthlessness and/or guilt, impaired concentration or decision
making, and suicidal ideation. A diagnosis of major depressive episode requires at
least two weeks of depressed mood or anhedonia accompanied by at least four
additional depressive symptoms. As in the etiology of burnout, unresolvable stress
plays a central role in the etiology of depression
- burnout—at least initially—is job-related and situation-specific whereas depression is
context-free and pervasive. the idea of a scopebased distinction between burnout and
depression is problematic in several respects. First, if conceptualizing burnout and
depression on a continuum (one is more or less burned out; one is more or less
depressed). depression, like burnout, can originate in suffering at work and develop as
occupational stress unfolds and intensifies. Second, if adopting a categorical, “all-or-
nothing” approach to burnout and depression (one is burned out or not; one is
depressed or not), it is worth observing that clinical burnout is pervasive in nature like
clinical depression. Third, attributing a given condition or disorder to a specific
domain (e.g., work) does not change the nature of this condition or disorder. Lastly,
the idea that burnout is, in its early stages, job-related and situation-specific whereas
depression is contextfree and pervasive says nothing about what distinguishes the late
stages of burnout from depression, leaving a key problem unresolved.
- Distinguishable symptoms: No burned out participant appeared to be free of
depressive symptoms. To date, isolating substantial differences between burnout and
depression at a symptom level has been challenging. Burnout seems irreducible to the
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, symptoms comprised by its dimensions (e.g., exhaustion, cynicism, and lack of
professional efficacy).
- Correlation: Among the three most studied components of burnout, emotional
exhaustion shows the strongest link to depression with moderate to high correlations.
The link of depression with depersonalization and reduced personal accomplishment
tends to be weaker, with low to moderate correlations being generally highlighted
- Distinguishable in factor analyses: Most factoring studies concluded that burnout can
be psychometrically distinguished from depression. However, two observations should
be made. First, how the factoring played out in these studies may be less related to
content (burnout versus depression) than to how the time frames and response
alternatives of the items are structured in the scales of interest. replacing possible
overlap between burnout and depression by definitional overlap between burnout and
neurasthenia
- Does one predict the other: The association of burnout with depression has been
observed in numerous cross-sectional studies. reciprocal causation between burnout
and depression. The authors detected no significant difference in strength between the
effect of an increase in job burnout on a subsequent increase in depression, and vice
versa. a circular causal relationship may exist between burnout and depression.
However, the findings are heterogeneous. Differences in follow-up duration, the
number of waves of measurement, and theoretical and statistical approaches are likely
to account for a great part of this heterogeneity
- Somatic and biological levels: t burnout was associated with hypocortisolism whereas
depression was marked by hypercortisolism. Hypercortisolism, however, characterizes
only a fraction of individuals presenting with the melancholic subtype of depression
and hypocortisolism has been related to atypical depression, another frequently-met
subtype of depression. Although the somatic and biological levels of analysis seem to
suggest some degree of discriminant validity of burnout and depression, the absence of
subtyping in the study of depression precludes any definite conclusion. Given that
opposite endocrine and vegetative profiles can be observed in depression depending
on its subtypes, not considering these subtypes is a major limitation in this field of
investigation
- Job related vs generic (general) factors: Burnout and depression have been found to
differ in their link to both job-specific and generic factors. However, the nature of this
difference remains difficult to characterize, notably because burnout is seldom
conceived as a unified entity. A particularly puzzling finding is the often-observed
stronger connection between depression and job specific factors than between job-
specific factors and burnout
2. How do you make a difference?
Article grossi
- The aim of this paper was to provide an overview of the literature on clinically
significant burnout, focusing on its assessment, associations with sleep disturbances,
cognitive impairments, as well as neurobiological and physiological correlates. Fifty-
nine English language articles and six book chapters were included. The results
indicate that exhaustion disorder (ED), as described in the Swedish version of the
International Classification of Diseases, seems to be the most valid clinical equivalent
of burnout. The data supports the notion that sleep impairments are causative and
maintaining factors for this condition. Patients with clinical burnout/ED suffer from
cognitive impairments in the areas of memory and executive functioning. The studies
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