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

Burn Out: Background Burn Out was described first by Burn Out was described first by –Maslach –Freudenberger As a specific job stress syndrome Burn Out is characterized by Burn Out is characterized by –Emotional exhaustion (  physical tiredness) –Cynicism –Demotivation Burn Out is Burn Out is –Insidious –Progressive (10 years)

Burn Out result of the repetition of adaptative behaviors toward job stress Adaptative behaviors Adaptative behaviors –Increase the emotional resistance –To care for without self involvement –To chose realistic targets Repetition => Burn Out Process Repetition => Burn Out Process –To proof oneself against emotions –Objectalization of the human intercourse –Restriction of the ambitions Terminal Burn Out Terminal Burn Out –Emotional exhaustion –Cynicism –Demotivation

Burn Out: Background Burn Out appears particularly at work and in jobs with Burn Out appears particularly at work and in jobs with –Vocation –Contact with the public –Work in teams –Where relational abilities are important But But The Maslach Burn Out Inventory (the most used test) can be applied only –On workers – who work with other people Tautology? Tautology?

Burn Out: Aim and hypothesis Is Burn Out a severe disease? Is Burn Out a severe disease? Has Burn Out severe outcomes? Has Burn Out severe outcomes? What are the Burn Out Characteristics? What are the Burn Out Characteristics? Is Burn Out a form of depression (smiling depression)? Is Burn Out a form of depression (smiling depression)? Is Burn out specific for some types of jobs? Is Burn out specific for some types of jobs?

Burn Out: Methodology Design: retrospective study Design: retrospective study Sample: Sample: –Source: outpatients of the “clinique du stress” CHU-Brugmann, Brussels since September 2002 to august –Inclusive criteria: Step 1: all patients who met the definition of a pathological chronic stress were assessed (N= 395) 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 –Inclusive criteria Step 2: Only patients who attribute the main source of stress to the job were maintained in the sample (N= 341) 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 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 Tools Tools Clinical assessment: Clinical assessment: –GHQ-28 of D. Goldberg (General Health Questionnaire) with 4 subscales Anxiety Anxiety Depression Depression Summarizations Summarizations Disability Disability –Beck Depression Inventory –Perceived stress of Cohen and Williamson –Stress at work of Legeron –Maslach Burn Out Inventory Attitudes and behaviors toward stress Attitudes and behaviors toward stress –Locus of control –Copings –Assertivity –Alexythymia (TAS-20) Clinical interview and follow-up by psychologists and/or psychiatrists Clinical interview and follow-up by psychologists and/or psychiatrists –Anamnesis data –Sociologic data –Treatment Drugs Psychotherapy Medical disablement to work

Burn Out: Results 1- How Bun Out is a severe disease?

Burn Out: Results 2- What are the outcomes?

Burn Out: Results 3- Characteristics: a) Attitudes toward stress Locus of control Locus of control –Internality (0 to 6) BO=8 Mean 2,53 sd 1,63 BO=8 Mean 2,53 sd 1,63 BO=0 Mean 3,38 sd 1,51 BO=0 Mean 3,38 sd 1,51 Anova p=.005 Anova p=.005 –Externality (0 to 6) BO=8 Mean 2,04 sd 1,51 BO=8 Mean 2,04 sd 1,51 BO=0 Mean 1,27 sd 1,13 BO=0 Mean 1,27 sd 1,13 Anova p=. 003 Anova p=. 003 => More externalists Copings Copings => worse copings

Burn Out: Results 3- Characteristics: a) Attitudes toward stress Emotions Emotions –Bad perceptions (0 to 35, cutting point 14) BO=8 Mean 23,38 sd 5,87 BO=8 Mean 23,38 sd 5,87 BO=0 Mean 19,15 sd 6,46 BO=0 Mean 19,15 sd 6,46 Anova p=.003 Anova p=.003 –Bad verbalizations (0 to 25, cutting point 10) BO=8 Mean 17,11 sd 3,99 BO=8 Mean 17,11 sd 3,99 BO=0 Mean 14,48 sd 4,38 BO=0 Mean 14,48 sd 4,38 Anova p=.007 Anova p=.007 –Avoidance of emotions (0 to 40, cutting point 16) BO=8 Mean 16,13 sd 4,57 BO=8 Mean 16,13 sd 4,57 BO=0 Mean 14,33 sd 4,00 BO=0 Mean 14,33 sd 4,00 Anova NS Anova NS => Worse perception and verbalization Assertivity Assertivity More passive and less assertive

Burn Out: Results 3- Characteristics: b) Sociological data No differences between BO=0 and BO=8 for 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: Results 3- Characteristics: c) Complaints

Burn Out: Discussion 1- Is Burn Out a form of depression? But 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? Is it due to the constructs of the scales? –GHQ: 3/7 questions on suicide –Beck: sadness preeminent Interest to use other scales Interest to use other scales –Other dysphoric expressions? Irritability –Anhedonia Or Burn Out is an other syndrome ? (Cynicism is not common in depressive disorders) 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 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 Chi Square –Burn Out Terminal Versus –No Burn Out in process Results Results –No significant differences Discussion Discussion –Sample to little? –Scale problem?

Burn Out: Discussion 2- Is Burn Out specific for some types of jobs?

Burn Out: Conclusions Burn Out is a severe disorder (GHQ=21) Burn Out is a severe disorder (GHQ=21) Outcomes 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 Characteristics –No sociological differences –Worse attitudes toward stress –Concentration and short memory impairments + tiredness Is Burn Out a form of depression? Is Burn Out a form of depression? –Probably no Is Burn Out specific for some types of work? Is Burn Out specific for some types of work? –No –But linked to work organization