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 …

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 …

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.

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.

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. …

A Five-Sample Confirmatory Factor Analytic Study Of Burnout-Depression Overlap, Renzo Bianchi, Irvin Sam Schonfeld, Jay Verkuilen

Publications and Research

Objective: It has been asserted that burnout—a condition ascribed to unresolvable job stress—should not be mistaken for a depressive syndrome. In this confirmatory factor analytic study, the validity of this assertion was examined.

Methods: Five samples of employed individuals, recruited in Switzerland and France, were mobilized for this study (N = 3,113). Burnout symptoms were assessed with the Shirom–Melamed Burnout Measure, the Maslach Burnout Inventory (MBI)—General Survey, and the MBI for Educators. Depressive symptoms were measured with the PHQ‐9.

Results: In all five samples, the latent factors pertaining to burnout’s components correlated on average more highly with the latent Depression …

Response To "From A Polemic Paradox To A Proper Perspective Of Job Burnout And Job Satisfaction, Eric Laurent, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

Juárez García and colleagues considered that “part of the conceptual and empirical problem of burnout is that many researchers force it into a biomedical disease model despite its being a psychosocial one.” Problematically, these authors’ scholastic argument a priori excludes biological or bodily factors from psychological conceptualizations. Scientists usually face considerable difficulties when trying to describe complex processes. If the understanding of biological processes sheds light on the complex processes that bear on burnout, then there is no reason to exclude research on those processes.

A Program Of Research On Burnout-Depression Overlap, Irvin Sam Schonfeld

Publications and Research

The article describes a program of research aimed at unraveling the nature of the relationship of job-related burnout to depression. The research tends to show that burnout symptoms are depressive symptoms and what is termed a state of burnout often reflects an episode of depression.

Burnout: Moving Beyond The Status Quo, Renzo Bianchi, Irvin Sam Schonfeld, Éric Laurent

Publications and Research

Burnout has been defined as a job-induced syndrome combining emotional exhaustion, depersonalization/cynicism, and a sense of reduced personal accomplishment. In this article, we expand on past analyses of burnout by reviewing key, yet overlooked, problems affecting the construct. We concomitantly examine the implications of these problems for the overall validity of burnout research. Our work shows that burnout research is undermined by 4 main problems. First, what constitutes a case of burnout is unclear. Second, the basic conceptualization and operationalization of burnout are ill aligned. Third, burnout is unlikely to be the specifically job-induced syndrome it has been posited to …

Inquiry Into The Correlation Between Burnout And Depression, Irvin Sam Schonfeld, Jay Verkuilen, Renzo Bianchi

Publications and Research

The extent to which burnout refers to anything other than a depressive condition remains an object of controversy among occupational health specialists. In three studies conducted in two different countries and two different languages, we investigated the discriminant validity of burnout scales by evaluating the magnitude of the correlation between (latent) burnout and (latent) depression. In Study 1 (N = 911), burnout was assessed with the Maslach Burnout Inventory–General Survey’s Exhaustion subscale and depression with the depression module of the Patient Health Questionnaire (PHQ). In Study 2 (N = 1,386), the Shirom–Melamed Burnout Measure was used to assess burnout and …

An Exploratory Structural Equation Modeling Bi-Factor Analytic Approach To Uncovering What Burnout, Depression, And Anxiety Scales Measure, Irvin Sam Schonfeld, Jay Verkuilen, Renzo Bianchi

Publications and Research

In this study, we addressed the ongoing debate about what burnout and depression scales measure by conducting an exploratory structural equation modeling (ESEM) bifactor analysis. A sample of 734 U.S. teachers completed a survey that included the Center for Epidemiologic Studies Depression scale (CES-D-10), the depression module of the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), and the Maslach Burnout Inventory (MBI), which contains emotional exhaustion (EE), depersonalization (DP), and (diminished) personal accomplishment (PA) subscales. Job adversity and workplace support were additionally measured for the purpose of a nomological network analysis. EE, burnout’s core, was more highly …

Burnout Research: Eyes Wide Shut, Irvin Sam Schonfeld, Eric Laurent, Renzo Bianchi

Publications and Research

In a study published in a recent issue of Critical Care Medicine, Colville and Smith (2017) found modest overlap between burnout and depression and assumed that burnout and depression are distinct entities. For four reasons, we think that the study is seriously flawed. First, Colville and Smith assessed burnout symptoms with an abbreviated version of the Maslach Burnout Inventory (MBI), the psychometric properties of which are unclear. Second, they used clinically and theoretically arbitrary cutoff scores for categorizing burnout, a modus operandi that, unfortunately, has become commonplace in studies of medical professionals. Third, participants could be categorized as “burned out” …

Burnout Syndrome And Depression, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

In this chapter, we proposed an overview of burnout, from the introduction of the construct in the mid-1970s to the growing realization that the syndrome was better conceived of as a depressive condition. Recent studies have shown that the distinction between burnout and depression is problematic, both theoretically and empirically. The history of burnout research suggests that transdisciplinary communication and methodological standards should be strengthened to avoid the proliferation of constructs that, in fact, refer to the same phenomena. Construct proliferation, a transgression of the scientific canon of parsimony, is considered a major problem today because it undermines theory building …

A Neglected Problem In Burnout Research, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Although we share with Eckleberry-Hunt et al. (2018) some of their criticisms regarding the problematic conceptualization of burnout, we are perplexed by the authors’ silence regarding burnout–depression overlap, which is arguably the most troubling problem attached to the burnout construct. The extensive research suggests that burnout reflects a combination of depressive responses. The emotional exhaustion component of burnout involves fatigue and depressed mood, two diagnostic criteria for depressive disorders. Maslach et al. (2001) wrote that there is “a predominance of dysphoric symptoms” in burnout. Depersonalization symptoms are commonly found in depressed individuals. Diminished personal accomplishment reflects well-known depressive manifestations of …

On The “Bubble” Of Burnout's Prevalence Estimates, Eric Laurent, Irvin Sam Schonfeld, Renzo Bianchi, Laura Hawryluck, Peter G. Brindley

Publications and Research

Hawryluck and Brindley (2018) addressed the issue of burnout—a syndrome thought to be induced by job stress—among critical care medicine (CCM) practitioners. Although we agree that the practice of CCM can be stressful, relying on burnout as an indicator of the practitioners’ response to occupational adversity is unwarranted. Despite its popularity, burnout remains poorly defined. Disconcertingly, investigators have widely relied on the Maslach Burnout Inventory (MBI) for “diagnosing” burnout in spite of the fact that the MBI is not a diagnostic instrument.Experiencing fatigue or distancing oneself from one’ work—what burnout is about—is not necessarily a sign of ill-being in itself. …

Burnout-Depression Overlap: Nomological Network Examination And Factor-Analytic Approach, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Burnout has been defined as a condition in which individuals are left exhausted by a long-term confrontation with unmanageable job stressors. The question of whether burnout reflects anything other than depressive responses to unresolvable stress remains an object of debate. In this 911-participant study (83% female; mean age: 42.36), we further addressed the issue of burnout-depression overlap. Burnout was assessed with the exhaustion subscale of the Maslach Burnout Inventory-General Survey (MBI-GS) and depression with the PHQ-8. The relationships of burnout and depression with three jobrelated variables – illegitimate work tasks, work-nonwork interference, and job satisfaction – and three “context-free” variables …

Interpretation Bias Toward Ambiguous Information In Burnout And Depression, Renzo Bianchi, Eric Laurent, Irvin Sam Schonfeld, Jay Verkuilen, Chantal Berna

Publications and Research

Burnout has been defined as a job-related syndrome combining pervasive fatigue and loss of motivation. In recent years, evidence has mounted that burnout may reflect a depressive condition. In this study, we expanded on past investigations of burnout-depression overlap by focusing on interpretation biases toward ambiguous information among the two entities. We conducted a web-based study involving 1056 participants (83% female; mean age: 42.87). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure and depressive symptoms with the PHQ-9. The Ambiguous Scenarios Test (AST), a measure of interpretation bias validated among dysphoric individuals, was the outcome of interest. The AST …