Depression-Burnout Overlap in Physicians

Abstract

Background: Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.

Methods: In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis.

Results: Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06) for physicians with mild, 10.14 (95% CI 7.58-13.59) for physicians with moderate, 46.84 (95% CI 35.25-62.24) for physicians with severe burnout and 92.78 (95% CI 62.96-136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85) of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.

Conclusions: This study demonstrates the overlap of burnout and major depression in terms of symptoms and the deficiency of the three-dimensional concept of burnout. In our opinion, it might be preferable to use multidimensional burnout inventories in combination with valid depression scales than to rely exclusively on MBI when clinically assessing burnout.

Conflict of interest statement

Competing Interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Hofmann reported relevant financial activities outside the submitted work (payment for lectures including service on speakers bureaus by Pfizer, GSK, TEVA). Hans-Peter Kapfhammer reports personal fees from Lundbeck, AOP, and Pfizer, outside the submitted work. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. MDI item means across UA, mild BO, moderate BO, severe BO and MD.

UA = physicians unaffected by burnout symptoms and major depression. BO = physicians suffering from burnout symptoms without suffering from major depression. Mild BO is characterized by an HBI_sum in the third quartile (a score between 145–178), individuals with moderate BO have an HBI_sum between the third quartile and ninth decile (a score between 179–200), and severe BO is characterized by an HBI_sum in the highest decile (a score of ≥ 201). MD = physicians suffering from major depression without suffering from burnout symptoms. T-tests revealed significant increases in all MDI item means across UA, mild BO, moderate BO, severe BO and MD (see S1 Table).