Psychometric and structural properties of the Karolinska Exhaustion Disorder Scale: a 1,072-patient study.

OBJECTIVE: Exhaustion disorder is a stress-related diagnosis that was introduced in 2005 to the Swedish version of the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). The Karolinska Exhaustion Disorder Scale (KEDS) was developed to assess exhaustion disorder symptomatology. While the KEDS is intended to reflect a single construct and be used based on its total score, the instrument's characteristics have received limited attention. This study investigated the KEDS's psychometric and structural properties in a large clinical sample. METHODS: The study relied on data from 1,072 patients diagnosed with exhaustion disorder that were included in two clinical trials in Sweden. We investigated the dimensionality, homogeneity, and reliability of the KEDS using advanced statistical techniques, including exploratory structural equation modeling (ESEM) bifactor analysis. RESULTS: A one-factor confirmatory analytic model exhibited a poor fit, suggesting at least a degree of multidimensionality. The ESEM bifactor analysis found the general factor to explain about 72% of the common variance extracted, with an omega hierarchical coefficient of 0.680. Thus, the ESEM bifactor analysis did not clearly support the scale's essential unidimensionality. A homogeneity analysis revealed a scale-level H of only 0.296, suggesting that KEDS's total scores do not accurately rank individuals on the latent continuum assumed to underlie the measure. The KEDS's reliability was modest, signaling considerable measurement error. CONCLUSION: Findings reveal important limitations to the KEDS with possible implications for the status of exhaustion disorder as a nosological category. TRIAL REGISTRATION: This study was pre-registered on Open Science Framework (osf.io) on April 24, 2022 ( https://osf.io/p34sq/ ).

Validation of the Occupational Depression Inventory in Sweden.

BACKGROUND: The Occupational Depression Inventory (ODI) was recently devised to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to overcome limitations in current assessments of job-related distress. This study aimed to validate the Swedish version of the ODI. METHODS: The study involved 365 individuals employed in Sweden. In addition to the ODI, the study included the Satisfaction with Life Scale, the Effort-Reward Imbalance Questionnaire, the Demand-Control-Support Questionnaire, the GAD-2, and the PHQ-9. We inquired into the factorial validity, dimensionality, scalability, test-score reliability, criterion validity, convergent validity, discriminant validity, and measurement invariance of the ODI. RESULTS: Exploratory structural equation modeling bifactor analysis indicated that the ODI's Swedish version meets the requirements for essential unidimensionality (e.g., explained common variance = 0.872). Measurement invariance held across sexes, age groups, and occupational categories. The instrument exhibited strong scalability (e.g., H = 0.662). The observed total scores thus accurately ranked respondents on the latent continuum underlying the scale. The ODI's total-score reliability was high (e.g., McDonald's ω = 0.929). Speaking to the instrument's criterion validity, we found occupational depression to correlate, in the expected direction, with various work (e.g., job support) and nonwork (e.g., general anxiety) variables. Occupational depression showed large correlations with effort-reward imbalance (r = 0.613) and demand-control imbalance (r = 0.566) at work. Multiple regression analyses supported these associations further. As expected, we observed both a degree of convergent validity and a degree of discriminant validity when examining the ODI against the PHQ-9, an attribution-free measure of depression. DISCUSSION: This study indicates that the ODI performs well within the Swedish context, consistent with the findings obtained in other linguistic and geographic contexts. The ODI promises to help researchers, practitioners, and public health decision-makers address job-related distress more effectively.

A five-sample confirmatory factor analytic study of burnout-depression overlap.

OBJECTIVE: It has been asserted that burnout-a condition ascribed to unresolvable job stress-should not be mistaken for a depressive syndrome. In this confirmatory factor analytic study, the validity of this assertion was examined. METHODS: Five samples of employed individuals, recruited in Switzerland and France, were mobilized for this study (N = 3,113). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, the Maslach Burnout Inventory (MBI)-General Survey, and the MBI for Educators. Depressive symptoms were measured with the PHQ-9. RESULTS: In all five samples, the latent factors pertaining to burnout's components correlated on average more highly with the latent Depression factor than with each other, even with fatigue-related items removed from the PHQ-9. Second-order factor analyses indicated that the latent Depression factor and the latent factors pertaining to burnout's components were reflective of the same overarching factor. CONCLUSIONS: This study suggests that the burnout-depression distinction is artificial.

Implicit and explicit attitudes towards sport among young elite athletes with high versus low burnout symptoms.

The development of cynical attitudes towards elite sport is a core symptom of athlete burnout and has been associated with dropout from elite sport. To date, this phenomenon has mainly been studied by investigating explicit attitudes towards sport, whereas athletes' automatic evaluations (i.e. implicit attitudes) that have been shown to influence behavior as well were not considered. This study aimed to compare explicit and implicit attitudes towards sport of young elite athletes with high (N = 24) versus low (N = 26) burnout symptoms. Using self-reported measures, general and athlete burnout symptoms were assessed. Additionally, a single-target implicit association test was administered to examine participants' automatic evaluation of sport. Statistical analysis revealed greater emotional/physical exhaustion and sport devaluation in athletes reporting high compared to low burnout symptoms. Implicit attitudes towards sport did not significantly differ between the groups. Furthermore, no significant correlations were observed between different athlete burnout symptoms and implicit attitudes. Athletes with high burnout symptoms show a tendency to explicitly detach themselves from sport, thus fostering sport devaluation as a core symptom of athlete burnout. However, this process does not seem to be reflected in their implicit attitudes towards sport.

Burnout and depressive symptoms are not primarily linked to perceived organizational problems.

In this 257-participant study (76% female; mean age: 44.84), we examined two ideas that are widespread among burnout researchers: (a) the idea that burnout is primarily related to occupational-level factors; and (b) the idea that burnout should be considered a sentinel indicator in research on negative occupational outcomes. We investigated the links between burnout and a series of generic and work-related variables, namely, depressive symptoms, neuroticism, extraversion, effort-reward imbalance in the job [ERI], social support at work (SSW), and turnover intention. Burnout was assessed with the Shirom-Melamed Burnout Measure, depressive symptoms with the PHQ-9, neuroticism and extraversion with the NEO-Five Factor Inventory, ERI with the 10-item version of the Effort-Reward Imbalance Questionnaire, SSW with the Job Content Questionnaire, and turnover intention with a dedicated 3-item measure. Correlation, multiple regression, and relative weight analyses were conducted. Burnout was not found to be more strongly linked to organizational and work-contextualized variables than to personality traits. In addition, turnover intention was not associated to a greater extent with burnout than with ERI. Burnout and depressive symptoms were highly correlated and exhibited overlapping nomological networks. Overall, our findings question the way burnout has been generally conceived.

Cross-Sectional and Longitudinal Associations Between Athlete Burnout, Insomnia, and Polysomnographic Indices in Young Elite Athletes.

Few studies have examined the association between sleep and burnout symptoms in elite athletes. We recruited 257 young elite athletes (Mage = 16.8 years) from Swiss Olympic partner schools. Of these, 197 were reassessed 6 months later. Based on the first assessment, 24 participants with clinically relevant burnout symptoms volunteered to participate in a polysomnographic examination and were compared with 26 (matched) healthy controls. Between 12% and 14% of young elite athletes reported burnout symptoms of potential clinical relevance, whereas 4-11% reported clinically relevant insomnia symptoms. Athletes with clinically relevant burnout symptoms reported significantly more insomnia symptoms, more dysfunctional sleep-related cognitions, and spent less time in bed during weeknights (p < .05). However, no significant differences were found for objective sleep parameters. A cross-lagged panel analysis showed that burnout positively predicted self-reported insomnia symptoms. Cognitive-behavioral interventions to treat dysfunctional sleep-related cognitions might be a promising measure to reduce subjective sleep complaints among young elite athletes.

Burnout-depression overlap: Nomological network examination and factor-analytic approach.

Burnout has been defined as a condition in which individuals are left exhausted by a long-term confrontation with unmanageable job stressors. The question of whether burnout reflects anything other than depressive responses to unresolvable stress remains an object of debate. In this 911-participant study (83% female; mean age: 42.36), we further addressed the issue of burnout-depression overlap. Burnout was assessed with the exhaustion subscale of the Maslach Burnout Inventory-General Survey (MBI-GS) and depression with the PHQ-8. The relationships of burnout and depression with three job-related variables - illegitimate work tasks, work-nonwork interference, and job satisfaction - and three "context-free" variables - social support, general health status, and trait anxiety - were examined. Burnout and depression were found to be strongly correlated, to cluster together, and to exhibit overlapping nomological networks. Remarkably, the average correlations of burnout and depression with job-related variables were almost identical. A principal component analysis and a principal axis factor analysis both showed that the items of the MBI-GS and of the PHQ-8 loaded on a single dimension. All in all, our findings are consistent with the view that burnout is a depressive condition. The distinction between burnout and depression may be an instance of the jangle fallacy.

Altered short-term plasticity within the working memory neural network: Is it neuroticism or is it depression?

In the present article, we discuss (1) the importance of assessing and statistically considering both clinical and subclinical forms of depression when examining the relationship between neuroticism and short-term plasticity within the working memory neural network, and (2) the hypothesis of an antagonism between neuroticism and conscientiousness in personality research. We suggest that (1) neuroticism and depression should be examined in a relational manner, and (2) neuroticism and conscientiousness should not be antagonized.

Burnout and Depression: Two Entities or One?

OBJECTIVES: The purpose of this study was to examine the overlap in burnout and depression. METHOD: The sample comprised 1,386 schoolteachers (mean [M]age = 43; Myears taught = 15; 77% women) from 18 different U.S. states. We assessed burnout, using the Shirom-Melamed Burnout Measure, and depression, using the depression module of the Patient Health Questionnaire. RESULTS: Treated dimensionally, burnout and depressive symptoms were strongly correlated (.77; disattenuated correlation, .84). Burnout and depressive symptoms were similarly correlated with each of 3 stress-related factors, stressful life events, job adversity, and workplace support. In categorical analyses, 86% of the teachers identified as burned out met criteria for a provisional diagnosis of depression. Exploratory analyses revealed a link between burnout and anxiety. CONCLUSIONS: This study provides evidence that past research has underestimated burnout-depression overlap. The state of burnout is likely to be a form of depression. Given the magnitude of burnout-depression overlap, treatments for depression may help workers identified as "burned out."

Emotional information processing in depression and burnout: an eye-tracking study.

Whether burnout is a form of depression is unclear. The aim of this study was to examine the relevance of the burnout-depression distinction by comparing attentional processing of emotional information in burnout and depression. Eye-tracking technology was employed for assessing overt attentional deployment. The gaze of 54 human services employees was monitored as they freely viewed a series of emotional images, labeled as dysphoric, positive, anxiogenic, and neutral. Similar to depression, burnout was associated with increased attention for dysphoric stimuli and decreased attention for positive stimuli. Hierarchical multiple regression analyses revealed that burnout no longer predicted these attentional alterations when depression was controlled for and vice versa, suggesting interchangeability of the two entities in this matter. To our knowledge, this study is the first to (a) investigate emotional attention in burnout and (b) address the issue of the burnout-depression overlap at both cognitive and behavioral levels using eye movement measurement. Overall, our findings point to structural similarities between burnout and depression, thus deepening concerns regarding the singularity of the burnout phenomenon.

Is burnout separable from depression in cluster analysis? A longitudinal study.

PURPOSE: Whether burnout and depression represent distinct pathologies is unclear. The aim of this study was to examine whether burnout and depressive symptoms manifest themselves separately from each other or are so closely intertwined as to reflect the same phenomenon. METHODS: A two-wave longitudinal study involving 627 French schoolteachers (73 % female) was conducted. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. RESULTS: Burnout and depressive symptoms clustered both at baseline and follow-up. Cluster membership at time 1 (T1) predicted cases of burnout and depression at time 2 (T2), controlling for gender, age, length of employment, lifetime history of depression, and antidepressant intake. Changes in burnout and depressive symptoms from T1 to T2 were found to overlap. Teachers with increasing burnout experienced increases in depression and teachers with decreasing burnout experienced decreases in depression. In addition, emotional exhaustion, the core of burnout, was more strongly associated with depression than with depersonalization, the second dimension of burnout, underlining an inconsistency in the conceptualization of the burnout syndrome. CONCLUSIONS: Our results are consistent with recent findings showing qualitative and quantitative symptom overlap of burnout with depression. The close interconnection of burnout and depression questions the relevance of a nosological distinction between the two entities. Emotional exhaustion and depersonalization, the two main dimensions of burnout, may be better conceptualized as depressive responses to adverse occupational environments than as components of a separate entity.

Is burnout solely job-related? A critical comment.

Within the field-dominating, multidimensional theory of burnout, burnout is viewed as a work-specific condition. As a consequence, the burnout syndrome cannot be investigated outside of the occupational domain. In the present paper, this restrictive view of burnout's scope is criticized and a rationale to decide between a work-specific and a generic approach to burnout is presented. First, the idea that a multidimensional conception of burnout implies a work-restricted scope is deconstructed. Second, it is shown that the burnout phenomenon cannot be confined to work because chronic, unresolvable stress - the putative cause of burnout - is not limited to work. In support of an integrative view of health, it is concluded that the field-dominating, multidimensional theory of burnout should abandon as groundless the idea that burnout is a specifically job-related phenomenon and define burnout as a multi-domain syndrome. The shift from a work-specific to a generic approach would allow both finer analysis and wider synthesis in research on chronic stress and burnout.

The Maslach Burnout Inventory is not a measure of burnout.

For decades, the Maslach Burnout Inventory (MBI) has been regarded as the "gold standard" for the assessment of burnout. The present paper demonstrates that the MBI fails to measure the construct it is purported to measure. On a deeper level, the problems affecting the MBI question the very idea of burnout. These problems may be unsurprising in light of the genesis of the burnout construct. Burnout emerged in the mid-1970s as a largely predefined entity. Burnout's definition was not predicated on robust empirical investigations or sound theorizing, nor was it anchored in a systematic review of the literature on stress and health. Interestingly, other measures deemed to assess burnout, such as the Oldenburg Burnout Inventory, similarly fail to measure what they are claimed to measure. Despite far-reaching implications for our ability to study and promote occupational health, the flaws that undermine the conceptualization and measurement of burnout remain widely underappreciated. We hope this paper will help raise awareness of these flaws and correct current practices in research on job-related distress. Alternatives to burnout do exist and may enable us to support our workforce more effectively.

Measurement invariance of the Pandemic Anxiety Inventory in different demographic groups.

BACKGROUND: The Pandemic Anxiety Inventory (PAI) was developed in the context of the COVID-19 pandemic. Its content allows it to assess anxiety in connection to any pandemic. Previous research has demonstrated the instrument's reliability and validity. An important question for clinicians and researchers, however, remains open: Does the PAI have similar meaning for members of different demographic groups? The finding of measurement invariance would allow clinicians and researchers to comparatively assess pandemic-related anxiety across demographic groups, including favored and disfavored groups. METHODS: We conducted a multi-group confirmatory factor analysis to assess the measurement invariance of the PAI using data obtained from a sample of 379 residents of the United Kingdom. RESULTS: The PAI demonstrated invariance across genders, age groups, individuals who are married or in a relationship and those who are not, as well as individuals with higher and lower incomes. In an ancillary analysis, we found invariance across subsamples of Whites and Nonwhites, although we note that the Nonwhite group was small (n = 60) and heterogeneous. The findings of a supplemental MIMIC analysis were consistent with the above. CONCLUSIONS: The PAI shows measurement invariance across a variety of demographic groups. Our findings suggest that the instrument can be meaningfully employed to compare pandemic-related anxiety across these groups.

Burnout, working alliance, and ward atmosphere: A multisite study of mental health professionals and patients with schizophrenia.

This study examined the association between burnout, psychological distress, ward atmosphere, and working alliance (WA) among mental health workers treating patients with schizophrenia spectrum disorder (SSD). Data were collected from 345 patients with SSD and 151 mental health workers across 98 residential facilities (RFs) as part of the DiAPAson project from October 2020 to October 2021. Participants were excluded from the study if they exhibited patient-operator matching errors, dropped out, or had many missing Maslach Burnout Inventory (MBI) scores. The final sample included 282 patients and 155 healthcare workers. Burnout was assessed using the MBI. Psychological distress was evaluated with the 12-item version of the General Health Questionnaire. WA and ward atmosphere were evaluated with the WA Inventory and the Ward Atmosphere Scale, respectively, in both staff and patients. Sociodemographic and clinical data was also collected and analysed. Burnout was associated with a less supportive ward atmosphere, a weaker WA, and higher staff distress. Severe psychiatric symptoms evaluated with Brief Psychiatric Rating Scale in patients were also linked to staff burnout levels. Discrepancies in the perceptions of the ward atmosphere and the WA were observed between staff and patients, with patients reporting better perceptions in both domains. Our findings highlight the complex dynamics of well-being within psychiatric care settings, emphasizing the importance of role clarity, professional autonomy, and a positive ward atmosphere in mitigating burnout. Interventions focused on such factors may help support mental health professionals involved in SSD patient care. ISRCTN registry ID ISRCTN21141466.

A validation study of the Occupational Depression Inventory in Poland and Ukraine.

This study examined the psychometric and structural properties of the Polish and Ukrainian versions of the Occupational Depression Inventory (ODI). We relied on two samples of Polish employees (NSample1 = 526, 47% female; NSample2 = 164, 64% female) and one sample of Ukrainian employees (NSample3 = 372, 73% female). In all samples, the ODI exhibited essential unidimensionality and high total-score reliability (e.g., McDonald's omegas > 0.90). The homogeneity of the scale was strong (e.g., 0.59 ≤ scale-level Hs ≤ 0.68). The ODI's total scores thus accurately ranked individuals on a latent occupational depression continuum. We found evidence of complete measurement invariance across our samples, a prerequisite for between-group comparisons involving observed scores. Looking into the criterion validity of the ODI, we found occupational depression to correlate, in the expected direction, with resilience and job-person fit in six areas of working life-workload, control, rewards, community, fairness, and values. The prevalence of occupational depression was estimated at 5% in Sample 1, 18% in Sample 2, and 3% in Sample 3. Our findings support the use of the ODI's Polish and Ukrainian versions. This study adds to a growing corpus of research suggesting that the ODI is a robust instrument.

Most people do not attribute their burnout symptoms to work.

A prevailing belief among researchers is that burnout is a work-specific syndrome induced by intractable job stress. The validity of this belief, however, remains unclear. This cross-sectional study compared burnout with two general conditions, nonspecific psychological distress (NSPD) and exhaustion, in terms of (a) causal attributions to work and (b) associations with 11 job variables (e.g., job satisfaction). The study involved 813 individuals employed in Norway (70.5 % female). Burnout was assessed with the Burnout Assessment Tool; NSPD, with the K6; and exhaustion, with the Karolinska Exhaustion Disorder Scale. Results showed that only 27.7 % of participants with burnout symptoms attributed these symptoms to work. The proportions of individuals ascribing their symptoms to work were similar for NSPD (26.9 %) and exhaustion (27.5 %). The higher one's burnout score, the higher the likelihood of attributing one's burnout, NSPD, and exhaustion symptoms to work. Overall, burnout shared more variance with job variables than did NSPD and exhaustion. Coworker support, job security, and job autonomy constituted notable exceptions. In multiple regression analyses, seven of the 11 job variables predicted NSPD; five predicted burnout and exhaustion. An a posteriori analysis of a nationally balanced quota sample of 591 U.S. employees (48.2 % female) replicated our main finding-only 35.9 % of participants attributed their burnout symptoms to work. This study invites stakeholders to exercise more caution when making etiological inferences about burnout. Assuming that symptoms experienced at work are necessarily caused by work may hinder our ability to mitigate these symptoms. Our findings further question work-centric views of burnout.