To the Editor: Eckleberry-Hunt and colleagues examined problems associated with burnout research.1 We share some of the criticisms reiterated by these authors regarding the conceptualization and measurement of burnout and agree with the idea that the burnout construct is so problematic that the medical education community “risk[s] not having a valid construct.” We are perplexed, however, by the authors’ silence regarding burnout–depression overlap, which is arguably the most troubling problem attached to the burnout construct.2,3
The extensive research on burnout that we have conducted over the years has led us to suggest that this syndrome is nothing other than a combination of depressive responses.2,3 The emotional exhaustion component of burnout involves fatigue and depressed mood, two diagnostic criteria for depressive disorders. The symptoms covered by the depersonalization component of burnout, such as loss of emotional involvement, irritability, and disengagement, are commonly found in depressed individuals; depressed mood and anhedonia are directly involved in such disinvestment processes. Diminished personal accomplishment, the third component of burnout, similarly reflects well-known depressive manifestations—namely, negative self-evaluation and feelings of failure.
Maslach and colleagues, well-known contributors to burnout research, themselves wrote that there is “a predominance of dysphoric symptoms” in burnout.4(p404) As a reminder, dysphoric symptoms lie at the core of depression. Surprisingly, this observation did not lead these authors to explicitly include dysphoria in their formal definition of burnout or to acknowledge that burnout problematically overlaps with depression.
Importantly, burnout–depression overlap is not limited to symptomatology. Burnout–depression overlap is also etiological. Depressive symptoms, either clinical or subclinical, do not appear out of nowhere. Research evidence from neuroscience, behavioral psychology, and psychiatry indicates that depressive symptoms constitute basic responses to unresolvable (e.g., job) stress—the putative cause of burnout—in individuals with no noticeable susceptibility to depression.2,3 These findings have also been overlooked in burnout research, perhaps because the initial development of the burnout construct was not clinically grounded, theory driven, or informed by the above-mentioned disciplines.3
Overall, it is regrettable that Eckleberry-Hunt et al1 ignored the problem of burnout–depression overlap given the centrality of this problem in burnout research.
Renzo Bianchi, PhD
Postdoctoral lecturer and researcher, Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland; firstname.lastname@example.org.
Irvin Sam Schonfeld, PhD, MPH
Full professor, Department of Psychology, The City College of the City University of New York, New York, New York.
Eric Laurent, PhD
Associate professor, Laboratory of Psychology (EA 3188), Bourgogne Franche-Comté University, Besançon, France.
1. Eckleberry-Hunt J, Kirkpatrick H, Barbera T. The problems with burnout research. Acad Med. 2018;93:367370.
2. Bianchi R, Schonfeld IS, Laurent E. Burnout or depression: Both individual and social issue. Lancet. 2017;390:230.
3. Bianchi R, Schonfeld IS, Vandel P, Laurent E. On the depressive nature of the “burnout syndrome”: A clarification. Eur Psychiatry. 2017;41:109110.
4. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397422.