Feeling burned out? The contributors could be more related to depression than you think
April 29, 2020
Science Daily/Medical University of South Carolina
Researchers found that similar factors cause both medical intern burnout and depression. These findings can be used to identify and treat burnout as well as mitigate the risk of burnout by modifying workplace factors.
An article published in the Journal of General Internal Medicine looks at the relationship between burnout and depressive symptoms in medical interns.
The article is authored by Constance Guille, M.D., an associate professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, and Lisa Rotenstein, M.D., an internal medicine resident at Harvard Medical School/Brigham and Women's Hospital, among others.
According to Rotenstein, these findings help correct a long-held misconception about burnout and depression.
"There is a long-standing thought that burnout is associated with workplace factors and that depressive symptoms are associated with workplace factors but also heavily influenced by personal factors," explained Rotenstein. "We found that the factors that drive burnout are much more closely related to the factors that drive depressive symptoms than previously realized."
In this study, Rotenstein and Guille uncover that there is substantial overlap between the factors that predict burnout and depressive symptoms. The study surveyed 1,552 medical interns entering residency programs at 68 different institutions about depressive symptoms, emotional exhaustion and depersonalization, as well as about potential contributing factors. Depressive symptoms were measured by a standard 9-item Patient Health Questionnaire, while emotional exhaustion and depersonalization were measured with a 9-item abbreviated Maslach Burnout Inventory. Workload and learning environment satisfaction were assessed with a standardized instrument. Personal factors assessed included age, gender, ethnicity, relationship status, sexual orientation, parenting status, specialty, self-reported history of depression, early life stress and neuroticism score.
The study found significant overlap between factors that contribute to depressive symptoms and those that contribute to burnout, with about two-thirds of variance in both depressive symptoms and burnout attributable to personal factors, and one-third of the variance in these measures attributable to workplace factors.
With more than 142 definitions circulating in the literature, the definition of burnout has historically been unclear. This lack of clear definition has led to highly variable rates of burnout being reported among medical interns, residents and attending physicians. In contrast, depressive symptoms are well-defined and have been clinically validated. The results of this study suggest that assessing for depressive symptoms may be a validated, standardized alternative to assessing for burnout among medical personnel. They also underscore that interventions that help address burnout may be effective in addressing depressive symptoms and vice versa. Examples of such interventions include leveraging resources such as scribes to address documentation burdens, time banking for physician service and resources such as childcare to take stress off those physicians with familial obligations.
For Guille, the takeaway message from this study is clear.
"Previous to this work, depression and burnout were conceptualized as separate entities with different factors contributing to these outcomes," explained Guille. "This work suggests there is substantial overlap between both workplace and personal factors that contribute to an increase in both depressive symptoms and burnout."
https://www.sciencedaily.com/releases/2020/04/200429105914.htm
Burnout linked with irregular heartbeat
January 14, 2020
Science Daily/European Society of Cardiology
Feeling excessively tired, devoid of energy, demoralised, and irritable? You may have burnout, a syndrome associated with a potentially deadly heart rhythm disturbance. That's the conclusion of a large study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
"Vital exhaustion, commonly referred to as burnout syndrome, is typically caused by prolonged and profound stress at work or home," said study author Dr. Parveen K. Garg of the University of Southern California in Los Angeles. "It differs from depression, which is characterised by low mood, guilt, and poor self-esteem. The results of our study further establish the harm that can be caused in people who suffer from exhaustion that goes unchecked."
Atrial fibrillation is the most common form of heart arrhythmia. It is estimated that 17 million people in Europe and 10 million people in the US will have this condition by next year, increasing their risk for heart attack, stroke, and death. Yet, what causes atrial fibrillation is not fully understood.
Psychological distress has been suggested as a risk factor for atrial fibrillation, but previous studies showed mixed results. In addition, until now, the specific association between vital exhaustion and atrial fibrillation had not been evaluated.
The researchers in this study surveyed more than 11,000 individuals for the presence of vital exhaustion, anger, antidepressant use, and poor social support. They then followed them over a period of nearly 25 years for the development of atrial fibrillation.
Participants with the highest levels of vital exhaustion were at a 20% higher risk of developing atrial fibrillation over the course of follow-up compared to those with little to no evidence of vital exhaustion.
While further study is needed to better understand the observed relationship, Dr. Garg noted that two mechanisms are likely at play. "Vital exhaustion is associated with increased inflammation and heightened activation of the body's physiologic stress response," he said. "When these two things are chronically triggered that can have serious and damaging effects on the heart tissue, which could then eventually lead to the development of this arrhythmia."
No connections were found between anger, antidepressant use, or poor social support and development of atrial fibrillation. "The findings for anger and social support are consistent with prior research but two previous studies did find a significant association between antidepressant use and an increased risk of atrial fibrillation. Clearly, more work still needs to be done," said Dr. Garg.
Further research is also needed to identify concrete actions for doctors to help patients with exhaustion, said Dr. Garg.
He concluded: "It is already known that exhaustion increases one's risk for cardiovascular disease, including heart attack and stroke. We now report that it may also increase one's risk for developing atrial fibrillation, a potentially serious cardiac arrhythmia. The importance of avoiding exhaustion through careful attention to -- and management of -- personal stress levels as a way to help preserve overall cardiovascular health cannot be overstated."
https://www.sciencedaily.com/releases/2020/01/200114173108.htm
The power of gratitude in the workplace
March 13, 2019
Science Daily/Portland State University
The study shows that being thanked more often at work predicted better sleep, fewer headaches and healthier eating, because it improved nurses' work satisfaction
If you knew that expressing gratitude to a colleague would improve their life and yours, would you do it more often?
A new study by Portland State University researchers -- business professor David Cadiz, psychology professor Cynthia Mohr, and Alicia Starkey, a recent Ph.D. graduate in psychology -- together with Clemson State University professor Robert Sinclair, exhibits a positive relationship between expressed workplace gratitude, physical health and mental health.
The study, "Gratitude reception and physical health: Examining the mediating role of satisfaction with patient care in a sample of acute care nurses," shows that being thanked more often at work predicted better sleep, fewer headaches and healthier eating, because it improved nurses' work satisfaction.
Improving Self-Care in a Stressful Work Environment
The study involved a group of Oregon nurses, a profession that has a particularly high rate of burnout. Cadiz discusses the findings and how applying the research can have a significant impact on quality of life and job retention by preventing stress-related illnesses and disease.
"Nurses tend to have a thankless job. It's very physical, and they're often being screamed at by patients who are at their lowest. When nurses receive gratitude, it boosts them," Cadiz explains.
"This type of study helps us understand how to keep nurses in the workforce in a healthy way. Nurses strongly align their profession with their identity and often look out for patients more than themselves. The gratitude matches up with their identity, gives them satisfaction in a job well done and ultimately increases self-care."
Many people inherently connect their identity to their job and feelings of appreciation within their roles. Employers who understand and react to this can create positive social and economic change.
Gratitude is Good Business
From an organizational, policy and leadership perspective, Cadiz says that employers should create formal or informal opportunities for people to express gratitude. Including gratitude in a business plan is an essential step that many business leaders miss, and that omission can have financial consequences.
"Employees that receive positive feedback are healthier, and that can impact the bottom line," adds Cadiz. "Preventing headaches and other stress-related symptoms means fewer sick days, and, in this case, cuts down the cost of replacement nurses and overtime pay."
These small changes can have a dramatic fiscal impact over time, which can result in more staff, better pay rates and increased benefits.
The big takeaway -- express gratitude when you see someone doing a good job. A positive feedback loop impacts you and those around you, and can ultimately shape a healthier and happier community.
https://www.sciencedaily.com/releases/2019/03/190313091929.htm
Doctors' burnout should be treated as organization-wide problem
December 5, 2016
Manchester University
Current approaches to dealing with burnouts in doctors on an individual case-by-case basis is not effective and the issue should instead be tackled with organization-wide initiatives, according to researchers.
A meta-analysis study, which brought together the results of previously conducted research, was carried out to explore the effectiveness of interventions in reducing burnout in doctors. It explored the comparison between doctor-directed interventions that target the individual and organisation-directed interventions that target the working environment. The strength of the doctor's experience and the particular healthcare setting they worked in was also assessed.
The research concluded that while doctor-focused tactics such as mindfulness and cognitive behavioural are important, the greatest success at preventing and reducing burnout in doctors can be achieved through the adoption of organisation-directed approaches such as improved working environment and organisational culture.
Burnout is a major problem in the healthcare industry and is often driven by excessive workload, imbalance between job demands and skills, a lack of job control and prolonged stress. It is a syndrome consisting of emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment. Importantly, burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction.
It was found that organisations that combined several elements such as structural changes, fostering communications between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout. However, such intense organisation-directed interventions were rare and had not been evaluated sufficiently.
What's more, the evidence indicated that young doctors starting out in their career, are at higher risk of burnout compared to those with more experience, and interventions focused on enhancing teamwork, mentoring, and leadership skills might be particularly suitable for this group.
Dr Maria Panagioti, Research fellow in Primary Care at the University of Manchester who led this study said: 'Our findings clearly show that we need more effective intervention models to prevent burnout in doctors. Such models could be organization-directed interventions which promote healthy individual-organization relationships and view burnout a problem of the whole healthcare systems.'
George Lewith, Professor of Health Research at the University of Southampton who supervised the research, said: "This work suggests that if we want to retain safe and professionally competent NHS clinicians working in very demanding front line jobs we need to support their mental and physical health and creating appropriate and enabling working environments for them. Efforts need to be focused on finding appropriate ways of reaching doctors who work in stressful environments to ensure their wellbeing is taken care of. If we don't patient safety could be at risk."
https://www.sciencedaily.com/releases/2016/12/161205120500.htm
Employees of medical centers report high stress, negative health behaviors
September 8, 2016
Science Daily/Mayo Clinic
Approximately 15 to 20 percent of adults in the U.S. will report high levels of stress, several American surveys have found. A new study has identified stress and burnout as a major problem employees face within the medical industry, leading to negative health behaviors. With rising stress levels in the workplace for employees, many companies are looking to integrate, engage and enroll employees into wellness programs.
"It's important to teach individuals to monitor their stress levels over time and practice effective, ongoing stress-reduction strategies, such as getting involved in wellness programs, this will in-turn help health care employees live a happy and health life," says Matthew Clark, Ph.D., lead author of the study and resiliency expert at the Mayo Clinic Healthy Living Program.
The study, which is published in the Journal of Occupational and Environmental Medicine, measured stress and health behaviors (exercise, nutrition, sleep, etc.) by a series of five annual surveys administered to 676 participants who are employees at Mayo Clinic and have access to a wellness center. A significant relationship was found between the stress levels of an employee and four domains of quality of life: poor physical health, low mental health, poor nutritional habits and lower perceived overall health. Unfortunately, according to the study, employees who reported high stress levels and perceived poor quality of life also reported the lowest usage of wellness programs.
According to Dr. Clark, "Increasing the awareness of wellness centers and programs in academic medical environments will increase the quality of life of employees and lead to less physician and staff burnout."
Many companies are taking note of burnout and job strain in their staff and have created wellness centers, offer stress reduction programs, provide wellness coaching and healthy sleep programs for their employees in an effort to reduce stress, job strain and burnout. Muscular strength, cardiovascular fitness and flexibility exercises are also beneficial to overall quality of life, Dr. Clark writes.
He adds, "We are beginning to encourage employees to monitor their stress levels and to engage in daily resiliency practices, such as exercise, time with family and friends, meditation or gratitude journaling, to help reduce their stress levels and improve their quality of life."
Given the significance of stress in the workplace, the researchers note that exploring ways to effectively engage employees who have high levels of stress into wellness programs warrants further investigation.
https://www.sciencedaily.com/releases/2016/09/160908165052.htm
Mindful Meditation, Shared Dialogues Reduce Physician Burnout
September 23, 2009
Science Daily/University of Rochester Medical Center
Training in mindfulness meditation and communication can alleviate the psychological distress and burnout experienced by many physicians and can improve their well-being, researchers report.
The training also can expand a physician's capacity to relate to patients and enhance patient-centered care, according to the researchers, who were led by Michael S. Krasner, M.D., associate professor of Clinical Medicine.
"From the patient's perspective, we hear all too often of dissatisfaction in the quality of presence from their physician. From the practitioner's perspective, the opportunity for deeper connection is all too often missed in the stressful, complex, and chaotic reality of medical practice," Krasner said. "Enhancing the already inherent capacity of the physician to experience fully the clinical encounter—not only its pleasant but also its most unpleasant aspects—without judgment but with a sense of curiosity and adventure seems to have had a profound effect on the experience of stress and burnout. It also seems to enhance the physician's ability to connect with the patient as a unique human being and to center care around that uniqueness.
"Cultivating these qualities of mindful communication with colleagues, anectodotally, had an unexpected benefit of combating the practitioners' sense of isolation and brought forth the very experiences that are such a rich source of meaning in the life of the clinician," he said.
"The most salient element was the collegial effect of weathered physicians reflecting on mutual experience using a theme-based approach in a safe environment," Chamberlain said. "It is a unique opportunity to return to our roots as physicians, exploring in a workshop format abstract yet key emotionally charged or difficult issues that many of us had not visited so academically since medical school. Perception of the impact and approach to those issues is quite different once tempered by experience, particularly in a program that emphasizes awareness of the moment. It is a singular opportunity to do-over some of our medical school experience, and get much more out of it than the first time, as one reflects on how others in the group have grappled with and addressed the complex experiences of being a physician whose life touches and is touched by others constantly. The program is all about the experience of being a physician. Not what to do, or how to do it, but what it feels like. That is unique, and quite refreshing."
http://www.sciencedaily.com/releases/2009/09/090922162259.htm