Are we burnt out on trying to define burnout?

50 years on from when the term was first coined, burnout continues to be a complicated and controversial phenomenon.

The term “burnout” was first described in the mid-1970s, and is defined by the World Health Organization as a feeling of exhaustion, increased disinterest or cynicism about one’s job, and a sense of ineffectiveness and lack of accomplishment in one’s occupation.

In a perspective published in the Medical Journal of Australia, researchers from the Norwegian University of Science and Flinders University (Adelaide) have examined the many misconceptions that surround the phenomenon of burnout.

“Although burnout has become a popular indicator of job-related distress, persistent controversies surround the construct,” the authors wrote.

“As burnout reaches its half-century of existence, this article offers an overview of key research developments that have prompted investigators to revamp their views of the syndrome.”

The burnout enigma

A signature feature of burnout has long been its relation to unresolvable job stress.

The 11th revision of the International Classification of Diseases states, “Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

However, the perspective authors note that longitudinal studies found only moderate association between job stressors and burnout, suggesting burnout is “predictive of, rather than predicted by,” work-related stress.

“There is no clear evidence that burnout is primarily caused by work, or that work contributes more to burnout than it does to other stress-related conditions — such as anxiety and depression,” the authors wrote.

Despite claims of a rising burnout epidemic, the authors note that it is difficult to accurately gauge the prevalence of burnout when there isn’t an agreed upon set of diagnostic criteria for it.

“In practice, burnout prevalence has been gauged using criteria that are not only clinically and theoretically arbitrary but also loose and heterogeneous,” the authors wrote.

“If developing diagnostic criteria for burnout, researchers should be mindful of diagnosis creep to avoid pathologising ordinary variations in stress, fatigue or motivation.”

Is burnout actually depression?

The authors note significant overlap in the symptoms of burnout and depression, with some researchers suggesting that burnout represents fragments of depressive symptomatology rather than a standalone syndrome.

“Studies of cognitive functioning, focusing on how people handle tasks and process stimuli in their environment, found that burnout involves alterations typical of depression,” the authors wrote.

As the distinction between burnout and depression remains unclear, the authors warn that demarcating the two conditions could have dire consequences.

“Depressive disorders require close medical attention and are a prime risk factor for suicidal behaviours,” the authors wrote.

“Separating burnout from depression may deprive people categorised as ‘burned out’ of access to potentially life-saving treatments.”

Redefining burnout

A closer look at burnout research reveals a shaky foundation for its credibility.

“Burnout surfaced in the literature through anecdotal reports and rudimentary studies in which the construct appeared largely predefined,” the authors wrote.

“These studies barely met any scientific standard (eg, in terms of measurement, data analysis or replicability) and were highly susceptible to observer bias (eg, confirmation bias).”

Some researchers have attempted to redefine burnout using a self-report questionnaire to clarify the symptoms.

However, the perspective authors note that self-reporting on burnout symptoms is inherently flawed, as every person has a different definition and experience of burnout.

“The term “burnout” is employed in everyday conversations with various meanings to describe various experiences,” the authors wrote.

“Assuming that non-specialists have a common understanding of the term when even researchers and practitioners disagree on its definition is a nonstarter.”

The perspective authors argue that researchers still have a way to go on defining exactly what burnout is.

“The question of whether burnout reflects a ‘genuine phenomenon’, irreducible to classical manifestations of distress (ie, anxiety and depressive symptoms) may require special attention as researchers further elucidate the burnout enigma.”

Read the perspective in the Medical Journal of Australia.

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