Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balance.

BACKGROUND: Burnout is generally perceived a unified disorder with homogeneous symptomatology across people (exhaustion, cynicism, and reduced professional efficacy). However, increasing evidence points to intra-individual patterns of burnout symptoms in non-clinical samples such as students, athletes, healthy, and burned-out employees. Different burnout subtypes might therefore exist. Yet, burnout subtypes based on burnout profiles have hardly been explored in clinical patients, and the samples investigated in previous studies were rather heterogeneous including patients with various physical, psychological, and social limitations, symptoms, and disabilities. Therefore, the aim of this study is to explore burnout subtypes based on burnout profiles in clinically diagnosed burnout patients enrolled in an employee rehabilitation program, and to investigate whether the subtypes differ in depression, recovery/resources-stress balance, and sociodemographic characteristics. METHODS: One hundred three patients (66 women, 37 men) with a clinical burnout diagnosis, who were enrolled in a 5 week employee rehabilitation program in two specialized psychosomatic clinics in Austria, completed a series of questionnaires including the Maslach Burnout Inventory - General Survey (MBI-GS), the Beck Depression Inventory, and the Recovery-Stress-Questionnaire for Work. Cluster analyses with the three MBI-GS subscales as clustering variables were used to identify the burnout subtypes. Subsequent multivariate/univariate analysis of variance and Pearson chi-square tests were performed to investigate differences in depression, recovery/resources-stress balance, and sociodemographic characteristics. RESULTS: Three different burnout subtypes were discovered: the exhausted subtype, the exhausted/cynical subtype, and the burned-out subtype. The burned-out subtype and the exhausted/cynical subtype showed both more severe depression symptoms and a worse recovery/resources-stress balance than the exhausted subtype. Furthermore, the burned-out subtype was more depressed than the exhausted/cynical subtype, but no difference was observed between these two subtypes with regard to perceived stress, recovery, and resources. Sociodemographic characteristics were not associated with the subtypes. CONCLUSIONS: The present study indicates that there are different subtypes in clinical burnout patients (exhausted, exhausted/cynical, and burned-out), which might represent patients at different developmental stages in the burnout cycle. Future studies need to replicate the current findings, investigate the stability of the symptom patterns, and examine the efficacy of rehabilitation interventions in different subtypes.

Systematic review: Factors associated with return to work in burnout.

BACKGROUND: Professional burnout predicts sick leave and even permanent withdrawal from the labour force. However, knowledge of the barriers to and facilitators of return to work (RTW) in such burnout is limited. AIMS: To identify factors associated with RTW of burned-out individuals to inform occupational health care (OHC) RTW policy. METHODS: A systematic search of peer-reviewed quantitative and mixed-method studies published from January 2005 to July 2016 in English and Finnish in ARTO, CINAHL (EBSCO), Medic, PsycINFO (ProQuest), PubMed, Scopus and Web of Science databases, followed by a manual search. We included studies that identify burnout with valid burnout measures and measure the degree of RTW or sick leave as outcomes. We excluded studies with heterogeneous samples without subgroup analyses of RTW in burnout cases. RESULTS: We included 10 studies (three experimental and seven observational) of the initial 1345 identified. The studies reported work-related factors; enhanced communication (positive association) and low control at work (negative association) and individual-related factors; male gender (positive association), covert coping (negative association), high over-commitment to work (positive association) and burnout-related factors; unimpaired sleep (positive association), duration of sick leave over 6 months (negative association) and part-time sick leave (positive association) associated with RTW in burnout. Associations between burnout rehabilitation and RTW, and the level of symptoms and cognitive impairment and RTW remained unclear. CONCLUSIONS: Few quantitative studies, of varied methodological quality, explore factors associated with RTW in burnout. Further research is needed to build an evidence base and develop guidelines for supportive OHC actions.

The impaired and/or disabled anesthesiologist.

PURPOSE OF REVIEW: Impairment and/or disability resulting from any of a number of etiologies will afflict a significant number of anesthesiologists at some point during their career. The impaired anesthesiologist can be difficult to identify and challenging to manage. Questions will arise as to if, how, and when colleagues, family members, or friends should intercede if significant impairment is suspected.This review will examine the common sources of impairment among anesthesiologists and the professional implications of these conditions. We will discuss the obligations of an anesthesiologist and his/her colleagues when there is sufficient suspicion that he/she might be impaired. RECENT FINDINGS: Substance use disorder remains one of the commonest sources of impairment among both resident and attending anesthesiologists. Other common etiologies of impairment include various physical ailments, major psychiatric disorders, especially depression and burnout, and age related dementia. Many regulatory organizations, healthcare systems, and state licensing agencies have developed programmes and protocols with which to identify and direct into treatment those suspected of significant impairment. SUMMARY: Some degree of impairment will occur to one-third of anesthesiologists during the course of their career. It is important to understand how such impairments might impact the safe practice of anesthesiology.

My Well-Being in My Own Hands: Experiences of Beneficial Recovery During Burnout Rehabilitation.

PURPOSE: To explore how burnout rehabilitation clients experienced their recovery from burnout and what they found beneficial in rehabilitation. SUBJECTS: Twelve clients whose burnout levels had declined during rehabilitation were interviewed at the end of the second period of the rehabilitation course. METHODS: Semi-structured interviews comprised the main material of the study and were analysed by content analysis. In addition, the Bergen Burnout Indicator (BBI-15) was used to measure the reduction in burnout levels. RESULTS: The analysis yielded a single overarching theme, My well-being in my own hands, and four categories. The overarching theme describes the overall process of recovery and the revelation experienced by clients that they are in charge of their own well-being. The process starts with Support from rehabilitation professionals, the client group and family or friends. The categories Awareness and Approval refer to specific changes in the attitude towards and recognition of one's needs and limits. The category Regained joy describes the culmination of the recovery process manifested in different spheres of life. CONCLUSIONS: The rehabilitation course proved particularly beneficial for individuals suffering from burnout. The accumulation of support, awareness and approval led to a revival of joy in life and greater perceived control over one's well-being.

[Stress Management Interventions at the Workplace Improve Perceived Stress Reactivity of Men at Higher Risk]. / Prävention stressbedingter Gesundheitsschäden in einem Industriebetrieb bei Männern mit erhöhtem Risiko.

A randomised controlled trial was conducted in a metal working plant. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS). 174 participants were randomly assigned to a stress-management intervention (SMI) (IG) or a waiting control group (CG). N=174 participants (171 male) were recruited at t0, 154 (89%) were still taking part after one year (t1), 131 (76%) after 2 years. The SRS score decreased in both groups. The conducted SMI proved to be effective over both a 1- and a 2-year period.

A prospective study of the association between the readiness for return to work scale and future work participation in Norway.

AIM: The aim of the study was to investigate the associations between the Norwegian version of the Readiness for return to work (RTW) scale and future work participation among persons in inpatient occupational rehabilitation. METHODS: A prospective cohort with one year follow up. The participants (n = 179) were persons with reduced work ability who participated in a one-week inpatient rehabilitation program. Four readiness for RTW factors were identified at baseline using explorative factor analysis: 'RTW inability' and 'RTW uncertainty' among persons not working, and 'uncertain work maintenance' and 'proactive work maintenance' among persons working. Work participation was measured as days without sickness benefits in the year following the rehabilitation program. The associations between work participation and readiness for RTW factors were analyzed in multivariate linear regression models controlling for gender, age, subjective health complaints, employment status and previous sickness benefit. RESULTS: High scores on the RTW inability factor were associated with low future work participation among persons not working before the rehabilitation program. Among persons working before the program, the proactive work maintenance factor was associated with high future work participation. Neither the RTW uncertainty factor nor the uncertain work maintenance factor was associated with future work participation. CONCLUSIONS: The associations between two readiness for RTW factors (RTW inability and proactive work maintenance) and future work participation indicate that these factors can be used as screening tools to tailor occupational rehabilitation programs.

[An art therapy project day to promote health for clients from burnout self-help groups--an exploratory study]. / Ein kunsttherapeutischer Projekttag zur Gesundheitsförderung bei Klienten aus Burnout-Selbsthilfegruppen--eine explorative Studie.

AIM: The present exploratory study dealt with the question whether a specialized concept of art therapy interventions could increase the current and habitual well-being for participants of burnout self-help groups. METHOD: Quantitative: pre-post: Current well-being: list of discomforts (Beschwerdenliste: B-L); current mood scale (Aktuelle Stimmungsskala: ASTS); Habitual well-being: quality of life (SF-36); qualitative: post: semi-structured interviews with open key questions; evaluation: structured content analysis of Mayring. RESULTS: Quantitative: significant increase of current and habitual well-being; qualitative: generation of 3 general and 8 specific art therapy work factors. CONCLUSION: Specialized resource-activating concepts of art therapy interventions can effectively complement existing programs for burnout prevention and health promotion.

Healing a vulnerable self: exploring return to work for women with mental health problems.

Mental health problems (MHPs) such as stress and depression are among the leading causes of work disability. In this article we explore how women with MHPs experience sickness absence and subsequent return to work. We conducted 16 semistructured interviews and employed constructivist grounded theory for the analysis. We found that whereas sickness absence constituted a major threat to positive self-images, the experience had potential as a personal growth experience: Although some women felt handicapped, others became stronger and more self-confident. The core of the experience was not the return to work but a process of healing a vulnerable self--the ability both to refocus attention from symptoms to other life goals and to maintain or reconstruct a positive self-image. Supportive health care and acknowledgment from others facilitated the healing process.

Will sick leave after a counselling intervention prevent later burnout? A 3-year follow-up study of Norwegian doctors.

INTRODUCTION: Burnout and mental distress in working doctors increase the risk for both suboptimal treatment of patients and negative health consequences for the doctors. Doctors have low rates of sickness absence and are reluctant to seek help, especially for mental distress. We examined whether a spell of sickness absence after a counselling intervention could predict reduction in emotional exhaustion among doctors at work 3 years later. METHODS: A 3-year follow up after a counselling intervention for burnout at the Resource Centre Villa Sana in Norway in 2003-05 was completed by 184/227 doctors. Self-report assessments were administered at baseline, 1-, and 3-years. The effect of number of weeks of sickness absence on reduction in emotional exhaustion among doctors working 3 years after the intervention was assessed by linear regression. RESULTS: Of the 184 doctors completing assessment, 149 were working at 3-year follow up. Emotional exhaustion (scale 1-5) was significantly reduced at follow up (from 3.00±0.96 to 2.37±0.79, p<0.001). The number of weeks of sickness absence after the intervention was a significant positive predictor of this reduction (ß=0.31, p<0.001), also after including sex, age, neuroticism, reduction of work hours, and other forms for treatment in the model. CONCLUSIONS: The number of weeks of sickness absence after a counselling intervention for burnout had a positive predictive effect on reduction in emotional exhaustion among doctors at work 3 years later. Sick leave thus seems to "prevent" later burnout, which can be of importance both for their patients and for the doctors themselves.

Health, sleep, and professional career in female white-collar workers back to work after long-term sick-listing due to minor mental disorders.

AIMS: This study is a 3-year follow up of female white-collar workers, who were on long-term sick leave in 2004 due to stress-related and minor mental disorders. The aim is to show what promotes return-to-work (RTW) and the impact of a long period of sickness absence on professional career. METHODS: The study includes a cohort of 233 women who were currently on medically certified sick leave lasting ≥90 days in 2004. A postal questionnaire was sent out after 34 months, regarding self-rated health, quality of sleep, sick-listing status, occupational status, etc. RESULTS: After 34 months, 69% of the women had fully returned to working life. One of the most salient findings is that almost half of those had changed jobs and more than a third were in a new profession. Those who were back in working life rated less negative consequences of the long-term sick-listing on their professional career and their quality of sleep was better (OR 2.90, 95% CI 1.50-5.60 "sleeping all night"). Self-rated health did not show significant association with RTW (OR 2.83, 95% CI 0.91-8.77). Those who had returned to working life reported more control over their lives (OR 1.98, 95% CI 1.01-3.88). CONCLUSIONS: The findings imply that, in work health promotion and rehabilitation and efforts to prevent sickness absence due to stress-related disorders, important factors to be considered are job mobility, changes in present work, improved sleep, and control over one's own life.

Work related factors and sick leave after rehabilitation in burnout patients: experiences from the REST-project.

INTRODUCTION: The aim of this study was to investigate the impact of psychosocial working conditions and coping strategies at work on change in sick leave level for patients on long-term sick leave due to burnout. METHODS: A cohort sample of patients (n = 117) on long-term sick leave due to burnout was analyzed. The patients answered a questionnaire at baseline and sick leave information was collected from the Swedish Social Insurance Agency at baseline and at follow-up 2 years later. Two groups were formed depending on whether the patients had "improved" and reduced their sick leave level (56%) or if the sick leave level was "unchanged" (44%) at follow-up. The association between change in sick leave and predictors measuring psychosocial working conditions and coping strategies at work were analyzed using logistic regression. RESULTS: The predictor, low control at work, was associated with unchanged sick leave at follow-up. When background characteristics were taken into account, usage of covert coping towards supervisors and covert coping towards workmates, respectively, also predicted unchanged sick leave level. High overcommitment was of borderline significance and associated with a reduced sick leave level at follow-up. CONCLUSIONS: Patients with burnout who have experienced low control at work and used covert coping towards supervisors and/or workmates have a higher risk of not reducing their sick leave after rehabilitation. The workplace may contribute to a reduction of sick leave lengths with a more flexible work environment and improvement in communication strategies for employees and supervisors.

Review of literature on the mental health of doctors: are specialist services needed?

BACKGROUND: Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to the public, yet they are often reluctant to seek help. AIMS: To review literature regarding risk factors and potential barriers to help-seeking unique to doctors; to consider the success of interventions by specialist services for doctors. METHOD: Key phrases regarding the 'mental health of doctors' were entered into internet searches and journal databases to identify relevant research. When key authors were identified, author-specific searches were carried out. FINDINGS: There are contradictory reports about the prevalence of mental ill health in doctors but it is generally agreed that doctors face a large number of risk factors, both occupational and individual; and help-seeking is difficult due to complexities surrounding a doctor becoming a patient. Specialist services developed specifically for interventions for doctors with mental health problems tend to show promising results but further research is needed. CONCLUSIONS: The unique and complex situation of a doctor becoming a patient benefits from specialist services; such services should focus on early intervention and raising awareness.

Revisiting job satisfaction and burnout in community mental health teams.

BACKGROUND: Staff morale is critical to the effectiveness and viability of teams and the models of care that they are implementing. AIMS: To update the findings on burnout, job satisfaction and sources of high or low morale in teams since the national survey of community mental health teams published by the Journal of Mental Health in 1997. METHOD: The literature on job satisfaction, stress and burnout in community mental health teams published between 1997 and 2010 is reviewed. RESULTS: Though beset with contradictory findings and inconsistent methodologies it is possible to conclude that although many studies report high levels of emotional exhaustion, there is no evidence for a decline in morale. Morale tends to vary across discipline and site location. Lack of resources and workload pressures remain the most consistent source of concern among staff. CONCLUSION: The literature on morale in teams is beset by inconsistent findings and methodologies that are inadequate to providing a generalisable perspective on the highly complex and inter-related factors affecting morale. Effective team working and good leadership, management, support and supervision appear to be protective factors that need further enhancement informed by evidence.

Experiences of women with stress-related ill health in a therapeutic gardening program.

BACKGROUND: Stress-related ill health, e.g. burnout, is of great concern worldwide. Effective rehabilitation programs need to be developed and their therapeutic aspects understood. PURPOSE: To explore and describe how women with stress-related ill health who are on sick leave experience the rehabilitation process in a therapeutic garden and how these experiences connect to their everyday lives. METHODS: This longitudinal study used methods from grounded theory. Five women completed three semi-structured interviews at three weekly intervals during rehabilitation and one interview three months after. Data were analyzed using a constant comparative approach. FINDINGS: A secure environment facilitated engagement in activities that provided feelings of enjoyment. These experiences inspired participants to add enjoyable activities in their everyday lives, contributing to occupational balance, despite worries of not be able to continue performing enjoyable activities. Implications. Effective rehabilitation programs need to focus on enjoyable activities in a protective environment to support achievement of occupational balance.

Return to work among employees with common mental disorders: study design and baseline findings from a mixed-method follow-up study.

AIMS: Most research on return-to-work (RTW) has focused on musculoskeletal disorders. To study RTW in employees sick-listed with common mental disorders (CMD), e.g., stress, depression, and anxiety, the National Research Centre for the Working Environment initiated a study on ''Common Mental Disorders, Return-to-work, and Long-term Sickness Absence'' (CORSA). The aim of the study is (1) to identify predictors of RTW from the environmental, the individual, and the health-related domain and (2) to explore the RTW process based on study participants' experiences. The purpose of this paper is to present the study design and the characteristics of the participants, including analyses on non-response and the prevalence of major depression. METHODS: CORSA is a mixed-method follow-up study encompassing quantitative and qualitative analyses in a cohort of employees sick-listed with CMD. Participants were all employees who suffered from CMD and whose applications for sickness absence benefits were processed by the Job Centre Copenhagen (a subunit of the municipality) between July and December 2007 (n = 721). Data on predictors for RTW were collected from (1) administrative application forms filled out by all participants when applying for benefits (n = 721), and (2) baseline questionnaires sent to all participants (responders: n = 298). Data on RTW was retrieved from a national sickness absence registry and from 6-month follow-up questionnaires (n = 226). To explore the RTW process we will primarily use data from in-depth interviews with selected participants (n = 16) supplemented with data from the two questionnaires. CONCLUSIONS: The mixed method design allows for a more comprehensive understanding of RTW by triangulating qualitative and quantitative methods.

[Workaholism: between illusion and addiction]. / Boulomanie: entre illusion et addiction.

Workaholism surfaced some years ago as a veritable addiction in the wide sense of the term, dependence. It differs from other sorts of dependence in that it is very often viewed in a positive perspective in the sense that it conveys to the person concerned the illusion of well-being, as well as a motivation and dedication in their professional activity. During the past 30 years, several authors have attempted to define this concept and to determine its characteristics. Robinson believes that workaholics have an approach to life whereby their work feeds on time, energy and physical activity. This provokes consequences that affect their physical health and interpersonal relationships. They have a tendency to live in the future rather than in the present. For Scott, Moore and Micelli , the compulsion for work is not necessarily viewed as being detrimental to one's health. Spence and Robbins highlight the notion of the pleasure experienced at work in their theoretical approach. The prevalence of the dependence on work is estimated at between 27 and 30% in the general population. It is correlated to the number of hours of work per week and tends to be higher as annual revenue increases. The sex ratio is 1, and the parents of children 5 to 18 years of age are the most susceptible to considering themselves workaholics. The physical and psychological consequences of professional exhaustion are characterized primarily by the decrease in self-esteem, symptoms of fatigue, anxiety, depression, irritability and the manifestation of physical problems including cardiovascular ailments, as evidenced by hypertension, as well as heart and kidney complications. All the theoretical point of views, from the psychoanalytical models to the contemporary models, highlight self esteem as being the centerpiece of the question regarding the problem of workaholism. In fact, the narcissism articulated from the sociological evolution of our western way of life permits us to delineate the psychic identity of the individual better, and therefore, to understand this reconstructive attempt of one's self better. In characterizing the personality traits of workaholic individuals, the doctor/therapist is required to deal with this new form of dependence as early as possible, in order to anticipate and avert the numerous personal, professional, social, relational and sanitary complications. Faced with this large prevalence of dependence on work, it seems important to us to look for a symptomatology that would emanate a signal of workaholism so as to envisage and propose to workaholic patients a specific course of action that would be adapted to their needs.

Combatting professional burnout through creative writing.

Physician burnout is becoming an increasing problem. In fact, nearly half of all physicians feel completely depleted, to the point where one in seven has contemplated suicide. Causes for burnout development include: administrative overload, regulatory restrictions, loss of autonomy or control, workplace issues, decreased access to medicines for patients, and electronic medical records. On the opposite end of this spectrum is physician fulfillment. Creative writing can be a therapeutic method of self-fulfillment. This may provide not only focused relief from burnout but also another possible avenue for success for multitalented people such as physicians.

The impact of program-driven wellness initiatives on burnout and depression among surgical trainees.

BACKGROUND: The prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. METHODS: A survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. RESULTS: The response rate was 44% among 369 residents. Of these, 63.2% screened positively for burnout, and 36.7% for depression. Residents who were burned out were more likely to work >80 h per week, have greater clerical duties, and miss educational activities more frequently. Conversely, having opportunities for wellness activities, dedicated faculty and housestaff wellness champions, and assistance with clerical burden were all associated with lower rates of burnout and depression. CONCLUSION: The presence of wellness support was associated with better outcomes, suggesting the value of initiatives to manage workload and support the well-being of surgical resident physicians.