When New Zealand Prime Minister Jacinda Ardern, who garnered international praise for how she handled the pandemic in her country, recently announced her intention to resign, here’s how she summed up her surprise decision: “I know what the job takes, and I know that I no longer have enough in the tank to do it justice.”
Social scientists and journalists worldwide largely interpreted Ardern’s words in her January 19 speech as a reference to burnout.
“She’s talking about an empty tank,” says Christina Maslach, a psychological researcher who has been interviewing and observing workers struggling with workplace-related distress for decades. In almost 50 years of interviews, says Maslach of the University of California, Berkeley, “that phrase [has come] up again and again and again.”
Numerous studies and media reports suggest that burnout, already high before the pandemic, has since skyrocketed worldwide, particularly among workers in certain professions, such as health care, teaching and service. The pandemic makes clear that the jobs needed for a healthy, functioning society are burning people out, Maslach says.
But disagreement over how to define and measure burnout is pervasive, with some researchers even questioning if the syndrome is simply depression by another name. Such controversy has made it difficult to estimate the prevalence of burnout or identify how to best help those who are suffering.
Here are some key questions researchers are asking to get a handle on the problem.
When did today’s understanding of burnout emerge?
Some researchers argue that burnout is a strictly modern-day phenomenon, brought on by overwork and hustle culture. But others contend that burnout is merely the latest iteration of a long line of exhaustion disorders, starting with the Ancient Greek concept of acedia. This condition, wrote 5th century monk and theologian John Cassian, is marked by “bodily listlessness and yawning hunger.”
The more contemporary notion of burnout originated in the 1970s. Herbert Freudenberger, the consulting psychologist for volunteers working with drug addicts at St. Mark’s Free Clinic in New York City, used the term to describe the volunteers’ gradual loss of motivation, emotional depletion and reduced commitment to the cause.
Roughly simultaneously, Maslach was interviewing social service workers in California and began observing similar characteristics. That prompted Maslach and her then–graduate student, Susan Jackson, now at Rutgers University in Piscataway, N.J., to develop the first tool to measure burnout, the Maslach Burnout Inventory. The duo defined burnout as comprising of three components: exhaustion, cynicism and inefficacy, or persistent feelings of low personal accomplishment.
Respondents rated statements on a scale from 0 (“never”) to 6 (“daily”). Sample statements read: “I feel emotionally drained from my work” for exhaustion; “I doubt the significance of my work” for cynicism; and “I have accomplished many worthwhile things in this job” for inefficacy. High scores for exhaustion and cynicism, and low scores for inefficacy, indicated that a person was struggling with burnout.
Maslach’s scale turned burnout into a legitimate area of inquiry, says Renzo Bianchi, an occupational health psychologist at the Norwegian University of Science and Technology in Trondheim. “Before [the Maslach Burnout Inventory], burnout was pop psychology.”
What is the best way to define burnout?
Maslach’s inventory remains the most widely used tool to study burnout. But many criticize that definition of the syndrome (SN: 10/26/22).
Conceptualizing burnout as a combination of exhaustion, cynicism and inefficacy is “arbitrary,” wrote organizational psychologists Wilmar Schaufeli and Dirk Enzmann in their 1998 book, The Burnout Companion to Study and Practice: A Critical Analysis. “What would have happened if other items had been included? Most likely, other dimensions would have appeared.”
Moreover, those three components and what’s causing them are themselves poorly defined, says work and organizational psychologist Evangelia Demerouti of Eindhoven University of Technology in the Netherlands. For instance, numerous nonwork factors can trigger exhaustion, such as health problems and caregiving responsibilities.
Disagreements over what constitutes burnout, and how to measure the phenomenon, has led to a chaotic body of literature. A key point of contention is how to use Maslach’s inventory. Maslach never designated a cutoff point at which a worker tips from not burnt out to burnt out. Rather the inventory was designed as a tool to help researchers identify patterns of burnout within a given work environment or profession.
But in practice, Maslach has little control over how researchers use the inventory. A review of 182 studies on physician burnout in 45 countries reported in September 2018 in JAMA is illustrative. Almost 86 percent of studies in that review used a version of the Maslach Burnout Inventory. But roughly a quarter of those studies used unofficial versions of Maslach’s scale, such as halving the number of statements or measuring exhaustion only. Those versions are clinically invalid, Maslach contends.
Moreover, most researchers using the inventory, or a modified version, did designate cutoff scores, though teams’ definitions for high, medium and low burnout showed little agreement. Consequently, estimates for the prevalence of physician burnout varied from 0 to 80.5 percent — figures that are impossible to interpret, the researchers note.
What’s more, across all the studies, the JAMA team identified 142 definitions of burnout. And among the subset of studies not using a version of the inventory, the researchers identified 11 unique methods for measuring burnout.
Those many concerns are prompting some researchers to call for a return to the drawing board on how to define and measure burnout. That process should start with qualitative interviews to see how people struggling at work speak about their own experiences, Demerouti says. “We don’t [have] a good conceptualization and diagnosis of burnout.… We need to start from scratch.”
Do researchers agree on any features of burnout?
Surprisingly, yes. Researchers concur that exhaustion is a core feature of the syndrome, wrote Bianchi and his team in March 2021 in Clinical Psychological Science.
Research in the past two decades is also converging on the idea that burnout appears to involve changes to cognition, such as problems with memory and concentration. Those cognitive problems can take the form of people becoming forgetful — missing a recurring meeting or struggling to perform routine tasks, for instance, says Charlie Renaud, an occupational health psychologist at the University of Rennes in France. Such struggles can carry over into people’s personal lives, causing leisure activities, such as reading and watching movies, to become laborious.
As these findings mount, some researchers have begun to incorporate questions on cognitive changes into their burnout scales, Renaud says.
Is burnout a form of depression?
At first glance, the two concepts appear contradictory. Depression is typically seen as stemming from within the individual and burnout as stemming from societal forces, chiefly the workplace (SN: 2/12/23). But some researchers have begun to question if burnout exists as a standalone diagnosis. The concepts are not mutually exclusive, research shows. Chronic stress in one’s environment can trigger depression and certain temperaments can make one more prone to burnout.
For instance, scoring high for the personality trait neuroticism — characterized by irritability and a tendency to worry — better predicted a person’s likelihood of experiencing burnout than certain work-related factors, such as poor supervisor support and lack of rapport with colleagues, Bianchi and his team reported in 2018 in Psychiatry Research.
Moreover, exhaustion occurred together with depression more frequently than with either cynicism or inefficacy, Bianchi and his team reported in the 2021 paper. If burnout is characterized by a suite of symptoms, then exhaustion and depression appear a more promising combination than the Maslach trifecta, the team reported.
“The real problem is that we want to believe that burnout is not a depressive condition, [or] as severe as a depressive condition,” Bianchi says. But that, he adds, simply isn’t true.
Should people be able to get a diagnosis of “burnout”?
Not everyone thinks that’s a good idea. “Burnout was never, ever thought of as a clinical diagnosis,” Maslach says.
Bianchi and his team disagree. The researchers have developed their own scale, the Occupational Depression Inventory, which assesses nine core symptoms associated with major depression, including cognitive impairment and suicidal thinking, through the lens of work. For instance, instead of rating a statement like “I feel like a failure,” participants rate the statement, “My experience at work made me feel like a failure.”
If burnout is a form of depression, then it can be treated as such, Bianchi says. And, unlike burnout, treatments for depression, such as therapy and, in severe cases, medication, are already established. “Hopefully the interventions, the treatments, the forms of support that exist for depressed people can then be applied for occupational depression,” he says.
But treating the individual, while often a necessary first step, does nothing to alleviate the work-related stress that triggered the crisis, says occupational health psychologist Kirsi Ahola of the Finnish Institute of Occupational Health in Helsinki. “[Imagine] the person is on sick leave, for example, for a few weeks and recuperates and rests … and he comes back to the exactly same situation where the demands are too high and no support and whatever. Then he or she starts burning out again.” That cycle is difficult to break.
Burnout is not included in the American Psychiatric Association’s current Diagnostic and Statistical Manual. The World Health Organization adopted Maslach’s conceptualization of burnout when they outlined the syndrome in their 2019 International Classification of Diseases. Burnout constitutes “an occupational phenomenon,” not a medical condition, the agency noted.
With the evidence so murky, is there any help for people struggling at work?
Most researchers agree that interventions must target work-related distress at all levels, from the individual to the workplace to governing bodies.
Interventions at the individual level include therapy, exercise, developing hobbies outside of work and crafting one’s job to better fit one’s goals (SN: 1/10/23). Additionally, cognitive training programs that help restore memory, attention and other cognitive deficits have shown promise in alleviating the cognitive problems associated with burnout, Renaud and University of Rennes developmental psychologist Agnès Lacroix reported January 2 in the International Journal of Stress Management.
At the workplace level, simple fixes, such as fewer video meetings and reducing distractions during the workday, can alleviate distress (SN: 4/7/21). It’s time to chip away at all the little changes that have increased people’s workload over time, Maslach says. “Everybody adds stuff to people’s work. They never subtract.”
Ultimately, though, it may take systemic changes, such as more stringent labor laws, to combat burnout in countries like the United States, where sick leave is seldom guaranteed and few rules protect employees from overwork and job insecurity.
But even without regulations forcing employers’ hands, governments and companies that prioritize healthy workplaces have a competitive advantage. “When people are feeling well and cope well and have energy, they are also better workers,” Ahola says.