Medicine and Health Sciences Commons^™

Examining The Evidence Base For Burnout, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Burnout has elicited growing interest among occupational health specialists in recent decades. Since 2019, the World Health Organization has characterized burnout as a syndrome resulting from chronic, unmanageable workplace stress. According to the ICD-11, three symptoms define the entity: feelings of exhaustion, increased mental distance from one’s job, and a sense of ineffectiveness at work, all of which correspond to the structure of the Maslach Burnout Inventory. The ICD-11 includes burnout among the factors that influence health status. This paper calls into question that conceptualization based on a number of lines of evidence. The evidence includes the following: burnout was …

Validation Of The Occupational Depression Inventory In Brazil: A Study Of 1,612 Civil Servants, Renzo Bianchi, Danísio Calixto Cavalcante, Cristina Queirós, Blezi Daiana Menezes Santos, Jay Verkuilen, Irvin Sam Schonfeld

Publications and Research

Objective: The Occupational Depression Inventory (ODI) assesses work-attributed depressive symptoms. The ODI has demonstrated robust psychometric and structural properties. To date, the instrument has been validated in English, French, and Spanish. This study examined the psychometric and structural properties of the ODI's Brazilian-Portuguese version.

Methods: The study involved 1612 civil servants employed in Brazil (MAGE = 44, SDAGE = 9; 60% female). The study was conducted online across all Brazilian states.

Results: Exploratory structural equation modeling (ESEM) bifactor analysis indicated that the ODI meets the requirements for essential unidimensionality. The general factor accounted for 91% of the common variance extracted. …

The Pandemic Anxiety Inventory: A Validation Study, Irvin Sam Schonfeld, Tasmyn Prytherch, Mark Cropley, Renzo Bianchi

Publications and Research

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

The Pandemic Anxiety Inventory: A Validation Study, Irvin Sam Schonfeld, Tasmyn Prytherch, Mark Cropley, Renzo Bianchi

Publications and Research

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

Toward A New Approach To Job-Related Distress: A Three-Sample Study Of The Occupational Depression Inventory, Renzo Bianchi, James Sowden, Jay Verkuilen, Irvin Sam Schonfeld

Publications and Research

The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to respond to limitations of current assessments of job-related distress, most notably, assessments relying on the burnout construct. In this study, we conducted a thorough examination of the psychometric and structural properties of the ODI using exploratory structural equation modelling bifactor analysis and Mokken scale analysis. The study involved three samples of employed individuals, recruited in France (N = 3454), Switzerland (N = 1971), and Australia (N = 1485). Results were consistent across the three …

Occupational Depression In Italy: Associations With Health, Economic, And Work-Life Characteristics, Renzo Bianchi, Caterina Fiorilli, Giacomo Angelini, Nicoletta Dozio, Carlo Palazzi, Gloria Palazzi, Benedetto Vitiello, Irvin Sam Schonfeld

Publications and Research

Background: The Occupational Depression Inventory (ODI) reflects a new approach to job-related distress centered on work-attributed depressive symptoms. The instrument was developed with reference to the characterization of major depression found in the DSM-5. The ODI has been validated in English, French, and Spanish. This study (a) investigated the psychometric and structural properties of the ODI’s Italian version and (b) inquired into the nomological network of occupational depression. Methods: A convenience sample of 963 employed individuals was recruited in Italy (69.9% female; mean age = 40.433). We notably relied on exploratory structural equation modeling bifactor analysis, common-practice …

Distress In The Workplace: Characterizing The Relationship Of Burnout Measures To The Occupational Depression Inventory, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

Burnout has been found to problematically overlap with depression. However, the generalizability of this finding remains disputed. This study examined burnout–depression overlap using the recently developed Occupational Depression Inventory (ODI) and two burnout measures, the Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI). The study involved two teacher samples employed in France (N = 1,450) and New Zealand (N = 492). We found the correlations of the ODI with (a) the MBI’s emotional exhaustion (EE) subscale and (b) the CBI to reach .80. An explanation of these high correlations based on content overlap in fatigue-related items was ruled …

Burned-Out With Burnout? Insights From Historical Analysis, Renzo Bianchi, Katarzyna Wac, James Francis Sowden, Irvin Sam Schonfeld

Publications and Research

Fierce debates surround the conceptualization and measurement of job-related distress in occupational health science. The use of burnout as an index of job-related distress, though commonplace, has increasingly been called into question. In this paper, we first highlight foundational problems that undermine the burnout construct and its legacy measure, the Maslach Burnout Inventory (MBI). Next, we report on advances in research on job-related distress that depart from the use of the burnout construct. Tracing the genesis of the burnout construct, we observe that (a) burnout’s definition was preestablished rather than derived from a rigorous research process and (b) the MBI …

The Impossible Situation? Impasse As Psychotherapeutic Paralysis, Possibility, And Progress, Leo Cancelmo

Dissertations, Theses, and Capstone Projects

Psychotherapeutic impasse has long been understood in the clinical literature as treatment stagnation and even failure, both from one-person and two-person psychodynamic perspectives. However, there is a dearth of empirical research that delves deeper to understand this complex and rich phenomenon. Using semi-structured interviews with nine psychodynamic therapists speaking about individual adult patients, this study examined experiences of impasse to better understand treatments that become embroiled in a kind of paralysis. Qualitative analyses revealed dyads where patients were conceptualized as struggling chronically with negative feelings about themselves and others, and who experienced traumatic personal histories. Impasse in and of itself …

Is The Phq-9 A Unidimensional Measure Of Depression? A 58,272-Participant Study, Renzo Bianchi, Jay Verkuilen, Sharon Toker, Irvin Sam Schonfeld, Markus Gerber, Elmar Brähler, Kurt Kroenke

Publications and Research

The PHQ-9 has become a measure of reference in depression research and clinical practice. However, the issue of the PHQ-9’s unidimensionality has not been fully elucidated, and the usability of the PHQ-9’s total score requires clarification. In this study, we examined the dimensionality, scalability, and monotonicity properties of the PHQ-9 as well as the scale’s total-score reliability. We did so based on exploratory structural equation modeling (ESEM) bifactor analysis and Mokken scale analysis (MSA). We relied on a total of 58,272 participants (63% female; Mage = 43, SDage = 13) from 29 samples involving seven different countries (e.g., Germany, the …

Occupational Depression In A Spanish-Speaking Sample: Associations With Cognitive Performance And Work-Life Characteristics, Bianchi Renzo, Guadalupe Manzano García, Maria Pilar Montanes, Emily A. Schonfeld, Irvin Sam Schonfeld

Publications and Research

This 386-participant study investigated the structural and psychometric properties of the Spanish version of the Occupational Depression Inventory (ODI). Exploratory structural equation modeling bifactor analysis revealed that the ODI meets the requirements for essential unidimensionality. Measurement invariance held across our sample and the English- and French-speaking samples used in the ODI’s initial validation study. Mokken scale analysis indicated that (a) the scalability of the instrument was strong, (b) no violations of monotonicity or local independence were present, and (c) invariant item ordering was sufficiently accurate. The ODI’s reliability was optimal. The ODI exhibited both convergent validity and discriminant validity vis-à-vis …

Reducing Fear Overgeneralization With Safety Learning: Attention Bias As A Moderator, Boyang Fan

Dissertations, Theses, and Capstone Projects

Anxiety disorders are the most prevalent mental health condition and affect one out of nine individuals around the world. Fear generalization is a neurocognitive mechanism thought to maintain and exacerbate anxiety, and thus is an important target of therapeutic interventions. Yet, intervention research and practice place relatively little emphasis on its importance. Given that a significant proportion of individuals do not respond to extant treatments of anxiety disorders, a strengthened focus on fear generalization may inform the development and personalization of new treatment approaches. Recent notions have linked fear generalization to failures in distinguishing between signals that predict the occurrence …

Identification Of Adhd And Comorbid Disorders In Children: The Potential Role Of Minority Group Membership, Rachel H. Tayler

Dissertations and Theses

Identification of ADHD and Comorbid Disorders in Children: The potential role of minority group membership

by

Rachel Tayler, MSc, MA

Advisor: Sarah O’Neill, PhD

Attention-Deficit/Hyperactivity Disorder (ADHD) affects six million US children. Females, Latinx, and possibly Black children have lower rates of diagnosis than their Male and White non-Latinx peers. ADHD is behaviorally defined, and as such, clinicians' perceptions of symptoms and determination of diagnoses may be influenced by demographic factors such as race, ethnicity and sex.

This vignette study examined whether clinicians' implicit ethnic, racial, and sex biases affect diagnosis of ADHD and comorbid conditions. Psychiatry trainees and pediatricians …

From Burnout To Occupational Depression: Recent Developments In Research On Job-Related Distress And Occupational Health, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

Job-related distress has been a focal concern in occupational health science. Job-related distress has a well-documented health-damaging and life-threatening character, not to mention its economic cost. In this article, we review recent developments in research on job-related distress and examine ongoing changes in how job-related distress is conceptualized and assessed. By adopting an approach that is theoretically, empirically, and clinically informed, we demonstrate how the construct of burnout and its measures, long favored in research on job-related distress, have proved to be problematic. We underline a new recommendation for addressing job-related distress within the long-established framework of depression research. In …

Who Needs To Be “Burned-Out”? Time For A New Approach To Job-Related Distress, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Burnout is a popular indicator of job-related distress, notably in research on the ill-being of medical professionals. The burnout construct is, however, plagued by definitional and measurement problems. Often unnoticed, these problems undermine findings and conclusions emanating from burnout research. The definitional and measurement problems affecting the burnout construct hamper knowledge growth, waste resources, and impede our ability to make informed decisions and take effective action to support personnel. It is time for occupational health specialists to abandon the idea of burnout and focus on occupational depression.

A Randomized Controlled Trial Of Psychological Outcomes Of Mobile Guided Resonant Frequency Breathing In Young Adults With Elevated Stress During The Covid-19 Pandemic, Al Amira Safa Shehab

Dissertations, Theses, and Capstone Projects

Deep breathing practices have shown promise in reducing stress, anxiety, and depression in different populations, including young adults. Specifically, resonant frequency breathing can exert an impact on stress response systems through the vagus nerve and the hypothalamo-pituitary-adrenal (HPA) axis. This may induce reductions in stress and improvement in emotion regulation. Young adults, including college students, tend to be at a higher risk for psychological distress, as they face several psychosocial challenges. The COVID-19 pandemic has imposed new and unique stressors that resulted in higher levels of stress and emotional symptoms and it has been shown that this may have placed …

Psychiatrist Burnout, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

We critique a paper published by Summers et al. (2020) and papers in general that, because of flawed methods, arrive at exceedingly high estimates of burnout in psychiatrists and other professionals.

Antecedents Of Borderline Personality Disorder And Antisocial Personality Disorder: An Examination Of Gene X Environment Interactions, Amy L. Medina

Dissertations, Theses, and Capstone Projects

Current thinking suggests that genotypes associated with impulse-control disorders and negative emotionality, such as monoamine oxidase-a (MAOA), interact with negative early environmental factors like childhood maltreatment and develop into the disorders know as Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). Using existing data from a prospective cohort design study of the consequences of child abuse and neglect, participants (N = 896 represent individuals with documented histories of child abuse and neglect and a matched comparison group that were followed up into adulthood and interviewed. A subsample of 631 participants gave permission for DNA extraction and analyses during …

The Occupational Depression Inventory—A Solution For Estimating The Prevalence Of Job-Related Distress, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

We are concerned about researchers’ reliance on the burnout construct and the MBI-GS to estimate the prevalence of job-related distress. In this paper, we first describe some of the problems plaguing the burnout construct and its measures. Then, we present the Occupational Depression Inventory, a new instrument designed to help occupational health specialists get a clearer view of the mental health status of the workforce (Bianchi and Schonfeld, 2020).

A Solution For Breaking The Impasse Of Burnout Measurement, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

In view of the profound problems affecting burnout’s conceptualization and measurement and because there is now robust evidence that burnout is a depressive condition, we recommend that occupational health specialists shift their focus from burnout to depression. A measure of job-related depressive symptoms, the Occupational Depression Inventory (ODI), has recently been developed. Advantageously, the ODI resolves many of the persistent problems linked to burnout while being consistent with burnout researchers’ original aim of assessing a work-attributed form of distress. The ODI includes a diagnostic algorithm that allows investigators to estimate the prevalence of depressive disorders that individuals specifically ascribe to …

Occupational Depression, Cognitive Performance, And Task Appreciation: A Study Based On Raven’S Advanced Progressive Matrices, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. Research on the criterion validity of the instrument is still in its infancy. In this study, we examined whether the ODI predicted performance on, and appreciation of, a cognitively challenging test. In light of the link established between clinical depression and neuropsychological impairment, and considering that individuals with depressive symptoms are more likely to feel helpless under challenging circumstances, we hypothesized that occupational depression would be associated with poorer cognitive performance and a darkened appreciation of the task undertaken. We relied …

Is Burnout A Depressive Condition? A 14-Sample Meta-Analytic And Bifactor Analytic Study, Renzo Bianchi, Jay Verkuilen, Irvin S. Schonfeld, Jari J. Hakanen, Markus Jansson-Fröjmark, Guadalupe Manzano-García, Eric Laurent, Laurenz L. Meier

Publications and Research

There is no consensus on whether burnout constitutes a depressive condition or an original entity requiring specific medical and legal recognition. In this study, we examined burnout–depression overlap using 14 samples of individuals from various countries and occupational domains (N = 12,417). Meta-analytically pooled disattenuated correlations indicated (a) that exhaustion—burnout’s core—is more closely associated with depressive symptoms than with the other putative dimensions of burnout (detachment and efficacy) and (b) that the exhaustion–depression association is problematically strong from a discriminant validity standpoint (r = .80). The overlap of burnout’s core dimension with depression was further illuminated in 14 exploratory structural …

The Occupational Depression Inventory: A New Tool For Clinicians And Epidemiologists, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Background: Depressive symptoms induced by insurmountable job stress and sick leave for mental health reasons have become a focal concern among occupational health specialists. The present study introduces the Occupational Depression Inventory (ODI), a measure designed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression. The ODI comprises nine symptom items and a subsidiary question assessing turnover intention. Methods: A total of 2254 employed individuals were recruited in the U.S., New Zealand, and France. We examined the psychometric and structural properties of the ODI as well as the nomological network of work-attributed depressive symptoms. …

Attachment, Exploration, And Internalized Homonegativity, Gregory J. Gagnon

Dissertations, Theses, and Capstone Projects

Background: Internalized homonegativity (IH; a.k.a. internalized homophobia), has been implicated in health disparities between lesbian, gay, and bisexual persons (LGBs) and their heterosexual peers. Yet, little available research has explored factors that may increase or decrease IH.

Objective: This dissertation investigates relations between child and adult attachment and IH. It further examines the mediating and moderating roles of exploration and mentalization, respectively, in the attachment–IH relation.

Method: One hundred fifty cisgender LGB adults participated in two waves of an online survey. The first assessed recalled child–maternal and child–paternal attachment and current attachment to the romantic partner. The second, conducted two …

Neurodevelopmental Mechanisms Of Adverse Trauma Outcomes In Emerging Adulthood, Olena Kleshchova

Dissertations, Theses, and Capstone Projects

Background: Exposure to traumatic stress and adversity during the formative years of development can have adverse effects on mental health, neuroendocrine stress system function, and the brain, that persist into adulthood. One candidate mechanism that might confer vulnerability to enduring adverse outcomes of early life trauma is disruption of normal brain maturation. As the brain matures, functional interactions among brain regions change until the functional brain architecture (i.e., the functional connectome) reaches a mature state in adulthood. Given that different neural circuits have distinct developmental trajectories and sensitive periods, traumatic stress at a given point in development might have …

Taking It To Heart: Trauma And Cardiovascular Risk In Court-Involved People Of Color, Tanya Erazo

Dissertations, Theses, and Capstone Projects

Research supports that racial disparities in health persist in the United States, with cardiovascular risk and cardiovascular disease remaining particularly high in low-income, communities of color (U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, 2013; Winkleby, Jatulis, Frank, & Fortmann, 1992). Public health literature often focuses on sociodemographic variables when assessing for health disparities without considering trauma or forensic populations. This dissertation provides an overview of literature that examines cardiovascular disease and its relationship to trauma, particularly in low-income, communities of color, and forensic populations. Although the dissertation culminates in providing results for an investigation …

Object Relations, Identity Formation, And Transitional Space In Religious Conversion, Arielle Rubenstein

Dissertations, Theses, and Capstone Projects

Conversion between broad religious groups is a life transformation undertaken by 15% of Americans, yet it has seldom been studied closely from a psychodynamic perspective. The psychological study of conversion began with a Protestant paradigm of sudden and total transformation of the self, and over time came to characterize different manifestations of conversion to more diverse religious groups. Research on conversion has primarily sought to understand whether conversion is essentially a psychopathological phenomenon, and has led to a multiplicity of both positive and negative, at times contradictory, findings. Research has shown that conversion is associated with insecure attachment, neurotic personality …

Sex/Gender Differences In Serial Position Profiles In Patients With Mild Cognitive Impairment And Healthy Controls, Emnet Z. Gammada

Dissertations, Theses, and Capstone Projects

Introduction: Alzheimer’s disease disproportionately affects more women, but paradoxically, men have a higher incidence of Mild Cognitive Impairment (MCI). Researchers have suggested that women’s verbal memory advantage across the lifespan reflects better premorbid skills, which then require more neurodegeneration to manifest early clinical impairment. To date, measurement of sex differences in verbal memory have used total list scores. We proposed that a granular examination of serial position effects (SPE) in list-learning can refine the source of sex/gender differences.

Methods: A cross-sectional analysis of participants with Mild Cognitive Impairment (MCI) and Healthy Controls (HC) was examined from the Alzheimer’s Disease Neuroimaging …

The Relationship Between Traumatic Brain Injuries, Impulsivity, And Crime, Brian Ramanauskas

Student Theses

The rate of traumatic brain injuries (TBIs) are increasing each year, impacting an estimated 1.4 million Americans. After further investigation, researchers have concluded that 8.5% of the general public sustains at least one TBI, whereas this number ranges from 25% to 87% in criminal populations. In the literature, impulsivity is frequently described as poorly conceived, prematurely expressed, or inappropriate behaviors. Additionally, poor impulse control has been shown to significantly impact the likelihood of criminal activity, increasing the rate of recidivism. The current study examined an archival dataset of 95 incarcerated individuals from a private correctional facility in a large mid-Atlantic …

Mechanisms Of Value-Biased Prioritization In Fast Sensorimotor Decision Making, Kivilcim Afacan-Seref

Dissertations and Theses

In dynamic environments, split-second sensorimotor decisions must be prioritized according to potential payoffs to maximize overall rewards. The impact of relative value on deliberative perceptual judgments has been examined extensively, but relatively little is known about value-biasing mechanisms in the common situation where physical evidence is strong but the time to act is severely limited. This research examines the behavioral and electrophysiological indices of how value biases split-second perceptual decisions and the possible mechanisms underlying the process. In prominent decision models, a noisy but statistically stationary representation of sensory evidence is integrated over time to an action-triggering bound, and value-biases …