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Burn Out Psychiatric impacts and psycho-social outcomes. Professor Philippe Corten Dewell P., From L., Friedrich A., Tiv Ph, Van Driette Y., Pelc I. Clinique du Stress - 2005. Burn Out was described first by Maslach Freudenberger As a specific job stress syndrome.

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burn out psychiatric impacts and psycho social outcomes

Burn OutPsychiatric impacts and psycho-social outcomes

Professor Philippe Corten

Dewell P., From L., Friedrich A., Tiv Ph, Van Driette Y., Pelc I.

Clinique du Stress - 2005

burn out background
Burn Out was described first by

Maslach

Freudenberger

As a specific job stress syndrome

Burn Out is characterized by

Emotional exhaustion

( physical tiredness)

Cynicism

Demotivation

Burn Out is

Insidious

Progressive (10 years)

Burn Out: Background
burn out result of the repetition of adaptative behaviors toward job stress
Adaptative behaviors

Increase the emotional resistance

To care for without self involvement

To chose realistic targets

Repetition => Burn Out Process

To proof oneself against emotions

Objectalization of the human intercourse

Restriction of the ambitions

Burn Out result of the repetition of adaptative behaviors toward job stress
  • Terminal Burn Out
    • Emotional exhaustion
    • Cynicism
    • Demotivation
burn out background4
Burn Out appears particularly at work and in jobs with

Vocation

Contact with the public

Work in teams

Where relational abilities are important

But

The Maslach Burn Out Inventory (the most used test) can be applied only

On workers

who work with other people

Tautology?

Burn Out: Background
burn out aim and hypothesis
Burn Out: Aim and hypothesis
  • Is Burn Out a severe disease?
  • Has Burn Out severe outcomes?
  • What are the Burn Out Characteristics?
  • Is Burn Out a form of depression (smiling depression)?
  • Is Burn out specific for some types of jobs?
burn out methodology
Design: retrospective study

Sample:

Source:

outpatients of the “clinique du stress” CHU-Brugmann, Brussels since September 2002 to august 2005.

Inclusive criteria:

Step 1: all patients who met the definition of a pathological chronic stress were assessed (N= 395)

Definition of a chronic pathological stress:

A persistent state of tension negatively perceived

Where someone is or feels unable to answer adequately to the task

Where this inability may have significant consequences

With psychological, physical and/or functional impact

Burn Out: Methodology
burn out methodology7
Inclusive criteria

Step 2: Only patients who attribute the main source of stress to the job were maintained in the sample (N= 341)

Step 3: Following the Maslach criteria the sample was divided in 3 subgroups

Terminal Burn Out (MBI = level 8)

Burn Out in process (MBI= 4 to 7)

No Burn Out (MBI= 0 to 3)

Step 4: statistical analysis were computed on the samples:

Terminal Burn Out (N=56)

Versus

No Burn Out (N=55)

Burn Out: Methodology
burn out methodology8
Tools

Clinical assessment:

GHQ-28 of D. Goldberg (General Health Questionnaire) with 4 subscales

Anxiety

Depression

Summarizations

Disability

Beck Depression Inventory

Perceived stress of Cohen and Williamson

Stress at work of Legeron

Maslach Burn Out Inventory

Attitudes and behaviors toward stress

Locus of control

Copings

Assertivity

Alexythymia (TAS-20)

Clinical interview and follow-up by psychologists and/or psychiatrists

Anamnesis data

Sociologic data

Treatment

Drugs

Psychotherapy

Medical disablement to work

Burn Out: Methodology
burn out results 3 characteristics a attitudes toward stress
Locus of control

Internality (0 to 6)

BO=8 Mean 2,53 sd 1,63

BO=0 Mean 3,38 sd 1,51

Anova p= .005

Externality (0 to 6)

BO=8 Mean 2,04 sd 1,51

BO=0 Mean 1,27 sd 1,13

Anova p=. 003

=> More externalists

Copings

=> worse copings

Burn Out: Results3- Characteristics: a) Attitudes toward stress
burn out results 3 characteristics a attitudes toward stress18
Emotions

Bad perceptions

(0 to 35, cutting point 14)

BO=8 Mean 23,38 sd 5,87

BO=0 Mean 19,15 sd 6,46

Anova p= .003

Bad verbalizations

(0 to 25, cutting point 10)

BO=8 Mean 17,11 sd 3,99

BO=0 Mean 14,48 sd 4,38

Anova p= .007

Avoidance of emotions

(0 to 40, cutting point 16)

BO=8 Mean 16,13 sd 4,57

BO=0 Mean 14,33 sd 4,00

Anova NS

=> Worse perception and verbalization

Assertivity

More passive and less assertive

Burn Out: Results3- Characteristics: a) Attitudes toward stress
burn out results 3 characteristics b sociological data
Burn Out: Results3- Characteristics: b) Sociological data
  • No differences between BO=0 and BO=8 for
    • Age: 42 years sd 9
    • Gender: 50% male, 50% female
    • Life milieu: 75% founded home
    • Civil status: 72% married
    • Children: 66%
    • Education: 69% University of High Schools
    • Work: 64% employee, 25% manager
burn out discussion 1 is burn out a form of depression
Burn Out: Discussion1- Is Burn Out a form of depression?
  • But
    • 66% of the patients with terminal Burn Out don’t reach the cutting points of these scales for major depression
  • Is it due to the constructs of the scales?
    • GHQ: 3/7 questions on suicide
    • Beck: sadness preeminent
  • Interest to use other scales
    • Other dysphoric expressions? Irritability
    • Anhedonia
  • Or Burn Out is an other syndrome ? (Cynicism is not common in depressive disorders)
burn out discussion 2 is burn out specific for some type of jobs
International literature attribute Burn Out to some type of jobs characterized by

Vocation

Contact with the public

Work in teams

Where relational abilities are important

Chi Square

Burn Out Terminal

Versus

No Burn Out in process

Results

No significant differences

Discussion

Sample to little?

Scale problem?

Burn Out: Discussion2- Is Burn Out specific for some type of jobs?
burn out conclusions
Burn Out: Conclusions
  • Burn Out is a severe disorder (GHQ=21)
  • Outcomes
    • Long time follow-up (12 months) and disablement (8,5 months for 75%)
    • 75% with anti depressive drugs + psychotherapy and relaxation
    • 80% go back to the labor market but only ½ at the same job and ¼ lose their jobs
  • Characteristics
    • No sociological differences
    • Worse attitudes toward stress
    • Concentration and short memory impairments + tiredness
  • Is Burn Out a form of depression?
    • Probably no
  • Is Burn Out specific for some types of work?
    • No
    • But linked to work organization