Occupational burnout
The ICD-11 of the World Health Organization (WHO) describes occupational burnout as an occupational phenomenon resulting from chronic workplace stress that hasn't been successfully managed, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."[4] It is classified as a mismatch between the challenges of work and a person's mental and physical resources, but is not recognized by the WHO as a medical condition.
"Burn out" and "Burn Out" redirect here. For other uses, see Burnout (disambiguation).Occupational burnout
Burn-out, exhaustion disorder, neurasthenia
Emotional exhaustion, depersonalization, reduced personal accomplishment,[1][2] fatigue[3]
Diagnosis[edit]
Classification[edit]
The two main classification systems of psychological disorders are the Diagnostic and Statistical Manual of Mental Disorders (DSM, used in North America and elsewhere) from the American Psychiatric Association (APA), and the International Classification of Diseases (ICD, used in Europe and elsewhere) from the World Health Organisation (WHO).
Burnout is not recognized as a distinct mental disorder in the DSM-5 (published in 2013).[54] Its definitions for Adjustment Disorders,[55][56][57] and Unspecified Trauma- and Stressor-Related Disorder[58] in some cases reflect the condition. 2022's update, the DSM-5-TR, did not add a definition of burnout.[59]
As of 2017, nine European countries may legally recognise burnout in some way, such as by providing workers' compensation payments.[5] (Legal recognition for financial purposes is not the same as medical recognition as a discrete disease.)
The ICD-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code Z73.0.[60] It was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding".[61] It was also considered one of the "problems related to life-management difficulty".[62] The condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia.[63] The ICD-10 also contained a medical condition category of "F43.8 Other reactions to severe stress."[64]
In 2005, the Swedish Board of Health and Welfare added “exhaustion disorder” (ED; F43.8A) to the Swedish version of the ICD-10, the ICD-10-SE, representing what is typically called "burnout" in English.[65][66] Swedish sufferers of severe burnout had earlier been treated as having neurasthenia.[67] According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country."[68]
The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder[69] as part of the ICD-10 system. In the Netherlands, overspannenheid (overstrain) is a condition that leads to burn-out.[70] In that country, burnout is included in handbooks and medical staff are trained in its diagnosis and treatment.[67] A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practitioners were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.[71]
According to the Dutch College of General Practitioners, there is overstrain if these four criteria are met:
Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role.[137][138] Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout.[139] One cause of burnout includes stressors that a person is unable to cope with fully.[140] A 2019 survey by Cartridge People concluded that workload was the main cause of workplace stress.[141]
Burnout is thought to occur when a mismatch is present between the nature of the job and the job the person is actually doing. A common indication of this mismatch is work overload, which sometimes involves a worker who survives a round of layoffs, but after the layoffs the worker finds that he or she is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organization's goals, but requires fewer employees to meet those goals.[142] The research on downsizing, however, indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than mere burnout; these health effects include increased levels of sickness and greater risk of mortality.[143]
The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI.[144] Lack of job resources was associated with the disengagement component of the OLBI.
Maslach, Schaufeli and Leiter identified six risk factors for burnout in 2001: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.[90]
Although job stress has long been viewed as the main determinant of burnout, recent meta-analytic findings indicate that job stress is a weak predictor of burnout.[145] These findings question one of the most central assumptions of burnout research.
In a systematic literature review in 2014, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) found that a number of work environment factors could affect the risk of developing exhaustion disorder or depressive symptoms:
The Stressmottagningen stress clinic believes "A certain type of person is considered to be at an increased risk of suffering from exhaustion disorder. The type includes creative, ambitious, perfectionist and emotionally committed individuals with a great need for appreciation, who find it difficult to delegate, find it difficult to say no to extra work and who find themselves in hierarchical organizations such as found in the healthcare, social care and education fields. Women aged between 35 and 50 are overrepresented in this category."[147] Swedish worker health organisation Suntarbetsliv quoted statistics in 2017 showing that "women in their 30s are most affected."[148]
The Gothenburg Institute of Stress Medicine's Kristina Glise wrote about a number of risk factors in February 2023.[149]
Negative consequences of burnout on both the employee and the organization call for preventive measures in order to reduce the impact of the risk factors. Burnout prevention strategies, either addressing to the general working population (primary prevention) or the occupational groups which are more vulnerable (secondary prevention), are focused on reducing the impact of risk factors. Reviews of healthcare professionals‟ burnout focusing on identifying risk factors have been conducted previously.[150]
A 2020 LinkedIn survey based on over 2.9 million responses concluded that employees struggling with work-life balance were 4.4 times more likely to show symptoms of occupational burnout.[151]
A Communication Perspective[edit]
In a study conducted by Andrea Meluch,[216] they studied how Communication Privacy Management can be applied to discussions about burnout across a diverse amount of sectors and industries. They found that discussing job burnout makes employees feel vulnerable and due to that feeling apply core and catalyst privacy rule criteria to help them make a decision about if they should disclose their job burnout. Core criteria is stable factors used to make choices about privacy rules while catalyst criteria refers to circumstantial influences that can cause a change in privacy rules. Meluch found the factors that contribute to if an employee discloses their feelings of burnout are if they feel that others in the company share the experience of burnout, the perceived judgment towards burnout, and the severity of the burnout they are feeling. Additionally the quality of the relationship they had and the level of trust they attributed to their coworkers and supervisors affected an employee's decision to disclose information. Meluch found that employees will conceal that they are burned out due to the level of risk and the worry about how they will be perceived in the workplace and how their work will be perceived.
Another study by Debbie Dougherty and Kristina Drumheller[217] explored how organizations manage the rationality/emotionality duality in the workplace. They found that in organizations that promote norms of rationality, organization members support the rationality/emotionality duality and accept and reinforce this duality by only focusing on emotions when they cause a disruption or rational practices and otherwise control their emotions. To privilege rationality over emotionality they usually recalled emotions in instances where their work was disrupted and rarely mentioned interpersonal conflict as emotional experiences. Additionally they would deny emotions, reframe emotions, rationally recite emotional experiences, and segment emotions “to a proper place and time”.[217] Organizational members would rationalize their emotions and emotional expression as well as take emotions out of their sense making to fit the expectation of being rational. Dougherty and Drumheller expressed how only privileging rationality and not also privileging emotionality can inspire extreme emotional control that can lead to explosive forms of emotional expression such as organizational violence. They propose that organizational members need to be more aware of “the complex and necessary role of emotions”, promote healthy emotional expression, and recognize that organizations are locations of both emotional and rational sense making.
Katie Kim and Yeunjae Lee[218] in their research on emotional exhaustion studied how emotional exhaustion is affected by organizations using transparent communication. They found when an employee feels emotionally exhausted, they have negative or cynical feelings towards their company and engage in negative communication behavior, such as complaining to external sources about their company. Kim and Lee express how this can affect organizations as their employees’ communication with external stakeholders can help with creating or losing an opportunity to build or maintain the organizations reputation. Employees can either share supportive views and Kim and Lee describe transparent communication as “an organization’s communication to make available all legally releasable information to employees whether positive or negative in nature”.[218] It involves sustainability, accountability, and participation. Sustainability is the timely, accurate and unambiguous information provided to employees. Accountability is the organization's responsibility to provide objective and balanced information on activities and policies whether negative or positive. Participation is that stakeholders are involved in identifying the information that needs to be provided. Through this means of communication, Kim and Lee, found that transparent communication provides employees with the resources they feel they lack and creates a more positive relationship with the organization. Transparent communication helped alleviate emotional exhaustion and helped employees cope with burnout symptoms.