Vital Exhaustion, Burnout, and Other Avatars of Depression

In our view, there is a worrying tendency in psychology and medicine to let proliferate “depression-like” constructs—a transgression of the scientific canon of parsimony. The problem is not limited to vital exhaustion (VE). Burnout, a condition akin to VE, has been shown to problematically overlap with depression. Compassion fatigue, a condition that shows particularly blurred definitional contours, is also uncomfortably close to depressive symptomatology. The construct of neurasthenia may be part of this confusing trend as well, although neurasthenia has been elevated to the status of nosological category in the ICD. Construct proliferation jeopardizes knowledge growth by undermining theory building and transdisciplinary communication. Instead of multiplying unnecessary variations on the theme of depression, we think that researchers should work at better coordinating dimensional and categorical approaches to depression. By enhancing such a coordination, researchers would allow themselves to better take into account both subclinical forms of depression and clinical subtypes of depression (e.g., depression with atypical features) in their empirical and theoretical analyses. Researchers who assume that VE, burnout, compassion fatigue, or neurasthenia lie outside the spectrum of depression should systematically adjust for depressive symptoms in their statistical analyses to corroborate their beliefs

Burned out at work but satisfied with one\u27s job: Anatomy of a false paradox

In a recent study of 346 US neurosurgery residents Attenello et al reported that 67% of their participants suffered from burnout. The authors also found that 81% of surveyed residents were satisfied with their career. Attenello et al described their results as paradoxical. We criticize their methodology

Burnout Symptoms: Depressive Manifestations Under Psychosocial Labels?

It can be concluded that burnout symptoms represent depressive symptoms under nonmedical labels. Our analysis supports the view that burnout is synonymous with depression and constitutes a roadblock to transdisciplinary communication

On the Overlap of Vital Exhaustion and Depression

Our reexamination of the symptoms and main measure of vital exhasution (VE) suggests that the overlap of VE with depression has been problematically underestimated due to inconsistent comparisons and blindness to definitional similarities. In our view, the case of VE is emblematic of a trend toward construct proliferation. Many ‘‘new’’ constructs are introduced in the literature precipitously, with insufficient examination of their added value, and based on ‘‘linguistic contortions’’ and anecdotal evidence rather than robust empirical findings and sound theorizing. Such constructs are often ‘‘distinguished’’ from existing ones on the basis of specious arguments and missing-the-point conclusions. This is for instance the case when Appels and Mulder overlook the fact that depressed mood and lowered self-esteem cannot be invoked to distinguish depression from VE because depressed mood and lowered self-esteem are constituents of demoralization, a component of VE. We plead for a greater respect of the principle of parsimony, in the interest of theoretical clarity and effective transdisciplinary communication

Is it Time to Consider the “Burnout Syndrome” A Distinct Illness?

The “burnout syndrome” has been defined as a combination of emotional exhaustion, depersonalization, and reduced personal accomplishment caused by chronic occupational stress. Although there has been increasing medical interest in burnout over the last decades, it is argued in this paper that the syndrome cannot be elevated to the status of diagnostic category, based on (1) an analysis of the genesis of the burnout construct, (2) a review of the latest literature on burnout-depression overlap, (3) a questioning of the three-dimensional structure of the burnout syndrome, and (4) a critical examination of the notion that burnout is singularized by its job-related character. It turns out that the burnout construct is built on a fragile foundation, both from a clinical and a theoretical standpoint. The current state of science suggests that burnout is a form of depression rather than a differentiated type of pathology. The inclusion of burnout in future disorder classifications is therefore unwarranted. The focus of public health policies dedicated to the management of “burnout” should not be narrowed to the three definitional components of the syndrome but consider its depressive core

The “burnout” construct: an inhibitor of public health action?

The prevention and treatment of the “burnout syndrome” within the critical care community is an important objective of the Moss et al. Burnout in the occupational area is based on the idea that burnout is especially common in individuals who care for critically ill patients. We think that the authors’ observations and recommendations are diminished by the fact that studies of burnout’s prevalence are methodologically problematic. The current definition and use of the burnout construct may in fact be detrimental to public health decision making

Is burnout a depressive disorder? A reexamination with special focus on atypical depression

Whether burnout and depression cover the same psychopathology remains to be elucidated. To date, subtypes of depression have been overlooked in research on the burnout–depression overlap. Our aim was to estimate the prevalence of depressive disorders in workers with burnout while examining the overlap of burnout with the atypical subtype of depression. The present study included 5,575 schoolteachers (mean age = 41 years; 78% female). Burnout was assessed with the Maslach Burnout Inventory. Depression was measured with the 9-item depression scale of the Patient Health Questionnaire (PHQ-9). Atypical features of depression were examined using a dedicated module, referenced to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). We found that 90% of the teachers identified as burned out met diagnostic criteria for depression. Among them, 92% scored 15 or higher on the PHQ-9, a threshold at which active treatment with pharmacotherapy and/or psychotherapy is recommended. The features of atypical depression were observed in 63% of the burned-out participants with major depression. Emotional exhaustion, the hallmark of burnout, was more strongly associated with depression than with depersonalization and reduced personal accomplishment, the 2 other putative dimensions of burnout. The present study suggests that the burnout–depression overlap has been largely underestimated. Atypical depression may account for a substantial part of this overlap. Overall, our findings point to depressive symptoms and depressive disorders as central concerns in the management of burnout. The clinical research on treatments for depression offers solutions that may help workers identified as burned out

On Parsimony and Tautology in the Study of Acute Coronary Syndrome

In a recent study, Zhang et al. concluded that burnout was associated with poor physical function and low quality of life after acute coronary syndrome (ACS). In our estimation, the authors\u27 study has at least two unnoticed, though major, methodological limitations: not controlling for depression and using a burnout scale that is a questionable choice

La pale d'hélicoptère: un concentré de technologie composite

Dans cet exposé, nous présenterons certains aspects et problématiques liés à la conception/réalisation de pâles composites à Eurocopter