Intended for healthcare professionals

Rapid response to:

Editorials

Burnout among doctors

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3360 (Published 14 July 2017) Cite this as: BMJ 2017;358:j3360

Rapid Response:

The ‘burnout epidemic’: An academic fiction?

Burnout has been defined as a work-induced syndrome combining emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment. In their editorial, Prs Lemaire and Wallace [1] provide us with an overview of the issue of burnout among doctors. According to these authors, despite heterogeneity in how burnout has been conceived of and assessed in past research, the overall evidence suggests that burnout has reached epidemic levels among physicians. In my estimation, the ‘burnout epidemic view’, although widely relayed in medical journals, is unsubstantiated.

Because there are no diagnostic criteria for burnout, the prevalence of burnout among physicians (or in any other occupational group) cannot be estimated [2]. As pointed out elsewhere, the spotlighted estimates of physician burnout prevalence rely on categorisation criteria that are (a) clinically and theoretically arbitrary, (b) malleable at convenience, and (c) potentially over-inclusive in view of what full-blown burnout has been assumed to be [3, 4]. Such research practices are eminently problematic and leave the ‘burnout epidemic view’ without any valid or reliable basis. Worryingly, the nosological blur surrounding burnout persists for more than 40 years, thus showing strong inertia. Considering that even the ability of burnout measures to specifically assess work-induced suffering is open to question [3, 5-7], it may be time to discuss the very use of the burnout construct in occupational health research.

Given the major problems affecting burnout research, and the well-established overlap of burnout with depression [2, 8], a resource-saving strategy may be to focus on job-related depression rather than burnout. By contrast with burnout, depressive disorders, under their various forms, are diagnosable [4]. Consequently, their prevalence can be accurately estimated. Methods for etiologically linking depression to work stress are available, in both research and clinical settings [2, 9]. Just as burnout, depression can be (a) examined from both a social and an individual standpoint [8] and (b) relevantly approached dimensionally (i.e., on a continuum, as a process) [10]. Regarding the often-raised issue of stigma, it is noteworthy that there is no clear evidence that the burnout label is currently less stigmatizing than the depression label [11, 12]. Interestingly, in a recent interview-based survey (N = 1,600), about eight of ten participants considered work stress a possible cause of depression—the study sample was representative of the general adult population of France in terms of place of residence, gender, age, and family status [13]. Such findings suggest that social representations of depression may be changing favourably among the Occidental public. All in all, focusing on job-related depression may boost research advance and allow us to more effectively protect doctors’ health in the future.

References

1. Lemaire JB, Wallace JE. Burnout among doctors. BMJ 2017;358:j3360. doi:10.1136/bmj.j3360

2. Bianchi R, Schonfeld IS, Vandel P, Laurent E. On the depressive nature of the “burnout syndrome”: a clarification. Eur Psychiatry 2017;41:109-110. doi:10.1016/j.eurpsy.2016.10.008

3. Bianchi R, Schonfeld IS, Laurent E. Can we trust burnout research? Ann Oncol in press. doi:10.1093/annonc/mdx267

4. Bianchi R, Schonfeld IS, Laurent E. Physician burnout is better conceptualised as depression. Lancet 2017;389:1397-1398. doi:10.1016/S0140-6736(17)30897-8

5. Hakanen JJ, Bakker AB. Born and bred to burn out: a life-course view and reflections on job burnout. J Occup Health Psychol 2017;22:354-364. doi:10.1037/ocp0000053

6. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. Personal life events and medical student burnout: a multicenter study. Acad Med 2006;81:374-384. doi:10.1097/00001888-200604000-00010

7. Verweij H, van der Heijden FM, van Hooff ML, Prins JT, Lagro-Janssen AL, van Ravesteijn H, Speckens AE. The contribution of work characteristics, home characteristics and gender to burnout in medical residents. Adv Health Sci Educ Theory Pract in press. doi:10.1007/s10459-016-9710-9

8. Bianchi R, Schonfeld IS, Laurent E. Burnout or depression: both individual and social issue. Lancet 2017;390:230. doi:10.1016/S0140-6736(17)31606-9

9. Rydmark I, Wahlberg K, Ghatan PH, Modell S, Nygren A, Ingvar M, Asberg M, Heilig M. Neuroendocrine, cognitive and structural imaging characteristics of women on longterm sickleave with job stress-induced depression. Biol Psychiatry 2006;60:867-873. doi:10.1016/j.biopsych.2006.04.029

10. Haslam N, Holland E, Kuppens P. Categories versus dimensions in personality and psychopathology: a quantitative review of taxometric research. Psychol Med 2012;42:903-920. doi:10.1017/S0033291711001966

11. Bianchi R, Verkuilen J, Brisson R, Schonfeld IS, Laurent E. Burnout and depression: label-related stigma, help-seeking, and syndrome overlap. Psychiatry Res 2016;245:91-98. doi:10.1016/j.psychres.2016.08.025

12. Dyrbye LN, Eacker A, Durning SJ, Brazeau C, Moutier C, Massie FS, Satele D, Sloan JA, Shanafelt TD. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med 2015;90:961-969. doi:10.1097/acm.0000000000000655

13. Angermeyer MC, Millier A, Remuzat C, Refai T, Toumi M. Attitudes and beliefs of the French public about schizophrenia and major depression: results from a vignette-based population survey. BMC Psychiatry 2013;13:313. doi:10.1186/1471-244x-13-313

Competing interests: No competing interests

18 July 2017
Renzo Bianchi
Lecturer and researcher in psychology
Institute of Work and Organizational Psychology, University of Neuchâtel
Émile-Argand 11, 2000 Neuchâtel, NE, Switzerland