Clinical Psychology 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 …

Illness Intrusiveness And Psychosocial Adjustment Among Older Adults With Multimorbidity, Irina Mindlis

Dissertations, Theses, and Capstone Projects

Given the high prevalence of multimorbidity (MM) among older adults and the exponential growth of the older adult U.S. population, identifying factors that can lessen depressive symptoms and improve quality of life (QOL) in this population is timely and important. While it is well established that MM is associated with greater depressive symptoms and poorer QOL (Li et al., 2016; Makovski et al., 2019; Marengoni et al., 2011; Read et al., 2017), the mechanisms underlying these relationships remain understudied. The illness intrusiveness model (Devins et al., 1984) proposes that stressors posed by diseases (disease-related factors) and their treatments (treatment-related factors) …

Ssri-Induced Emotional Blunting: A Study Of Cognitive Changes In Pharmaceutically Treated Depression, Carly Tocco

Dissertations, Theses, and Capstone Projects

Objective: In recent years, approximately 12.7% of the American population are on a prescribed antidepressant medication. Selective Serotonin Reuptake Inhibitors (SSRIs) are a widely used pharmacological treatment for depressive and anxiety disorders, primarily due to their tolerance levels, mild side effects in comparison to other antidepressants, and broad range of clinical indications. However, there are still numerous concerns about SSRIs’ ability to improve depressive symptoms without adding side effects such as sexual dysfunction, gastrointestinal upset, and a restricted range of emotions. Although patients typically claim that they have less emotional pain while on SSRIs than they do during a depressive …

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 …

Loneliness, Interpersonal Sensitivity And The Mechanisms Through Which The Dimensions Of Trait Emotional Intelligence May Protect Against Clinical Depression, Eva H. Leighton

Dissertations and Theses

Reducing the prevalence of loneliness and depression are important public health objectives. This dissertation aims to contribute to these objectives by improving our understanding of the relationship between loneliness and depression. Specifically, we assessed three additional constructs known to be strongly associated with loneliness and depression –-perceived social support, emotional intelligence, and interpersonal sensitivity –- with the aim of showing how these three constructs influence the relationship between loneliness and depression. Previous research that jointly examines all five constructs has not been identified by the author in an extensive search of prior literature.

Specifically, this dissertation tested the following hypotheses: …

Being Black & Blue: Sex As A Moderator Between Adverse Childhood Experiences And Depressive Symptoms Among Black Emerging Adults, Wynta C. Alexander

Dissertations and Theses

Adverse Childhood Experiences (ACEs) have been linked to adult mental health consequences (e.g., depressive symptoms). Black people are disproportionately affected by ACEs, and factors related to ethnic subgroups and/or sex may produce differential depressive outcomes. The current study examined the moderating role of sex in the association between adverse childhood experiences and depression symptoms using a life course of health approach among a sample of Black emerging adults. Participants (n = 159) of the current study were Black (e.g., African – American) and Black Caribbean (e.g., Jamaican) undergraduate students (18 – 59 years old; 72.3% female) attending a large, public …

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 …

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.

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. …

Memory Bias Toward Emotional Information In Burnout And Depression, Renzo Bianchi, Eric Laurent, Irvin Sam Schonfeld, Lucas M. Bietti, Eric Mayor

Publications and Research

A sample of 1015 educational staff members, exhibiting various levels of burnout and depressive symptoms, underwent a memory test involving incident encoding of positive and negative words and a free recall task. Burnout and depression were each found to be associated with increased recall of negative items and decreased recall of positive items. Results remained statistically significant when controlling for history of depressive disorders. Burnout and depression were not related to mistakes in the reported words, or to the overall number of recalled words. This study suggests that burnout and depression overlap in terms of memory biases toward emotional information.

Does Overweight/Obesity Moderate The Association Between Adhd And Internalizing Difficulties In Young Adults?, Breanna Badripersaud

Dissertations and Theses

This study’s objective was to investigate if ADHD symptoms and BMI are associated with internalizing impairments of depression, anxiety, stress and lower self-esteem in college students. It was predicted that higher ADHD symptoms would be associated with elevated depression, anxiety, stress, and low self-esteem, especially if BMI fell in the overweight/obese range. Undergraduate students [N= 580; Mean (SD) age= 20.7 (3.10)] from an urban campus completed an online survey comprising self-report measures of demographics, height/weight, attention and hyperactivity/impulsivity (Barkley Deficits Executive Functioning Scale ADHD- Executive Function Index), depression, anxiety, stress (all using the Depression Anxiety and Stress Scale) and self- …

The Epidemiology Of Somatic Depression And Eating Disorders: The Relationship Between Depressive Subtypes And Symptoms Of Disordered Eating, Anita M. Sicignano

Dissertations and Theses

Depression is known to affect females in much greater numbers than males, with about three times as many women having the disorder as men (American Psychiatric Association, 2013). A similar gender disparity can be seen in eating disorders, where up to nine in ten sufferers are female (American Psychiatric Association, 2013). Studies have shown that most of the gender difference in depression occurs as a result of women experiencing a form of depression involving a number of body-centric symptoms, including headaches, weight changes, fatigue, and insomnia, which has been termed “somatic depression” (Silverstein et al., 2013). Some of the 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 …

The Impact Of Racial Microaggressions And Major Discriminatory Events On Mental Health, Florence Lui

Dissertations, Theses, and Capstone Projects

The current study, a secondary data analysis, sought to determine the number and nature of latent groups for experiences of spectrum racial discrimination (i.e., both major and microaggressive racial discrimination) in a sample of emerging adults from a people of color (POC)-majority public university setting in the United States, and to understand the role of socio-demographic variables in defining each group. In addition, the study aimed to ascertain the extent to which endorsing spectrum racial discrimination experiences predicted anxiety and/or depression above the effects of general, non-race-related stress. Finally, the analyses gauged the mediating and/or moderating role of coping in …

Clinical Characteristics And Neuroanatomical Predictors Of Acute Antidepressant Outcome For Patients With Comorbid Depression And Mild Cognitive Impairment, Jeffrey N. Motter

Dissertations, Theses, and Capstone Projects

Background: Older adults presenting with both a depressive disorder (DEP) and cognitive impairment (CI) represent a unique, understudied population. The classification of cognitive impairment severity continues to be debated though it has recently been subtyped into late (LMCI) versus early (EMCI) stages. Previous studies have found associations between treatment outcome and both cortical thickness and white matter hyperintensities (WMH), though report inconsistent directionality and affected regions. In this study, we examined baseline clinical characteristics and neuroanatomical features as prognostic indicators for older adults with comorbid DEP and CI participating in an open antidepressant trial. EMCI is hypothesized to have greater …

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.

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: 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 …

Threat-Related Attentional Bias In Relation To Anxiety And Depressive Symptoms In The General Population: The Potential Role Of Sex Effects, Beril Yaffe

Dissertations, Theses, and Capstone Projects

Heightened sensitivity to relevant environmental stimuli (attentional bias) has been observed in relation to clinical and non-clinical anxiety and depression symptoms. While depression symptoms are associated with sensitivity to disorder and self-relevant words, hypervigilance to threatening stimuli is observed in relation to anxiety symptoms. Furthermore, attentional bias has been shown to play an important role in the development and maintenance of depressive and anxiety disorders. Accordingly, a large body of literature has examined threat-related attentional bias in relation to symptoms of anxiety and depression. However, several methodological inconsistencies exist across studies, including variability in definitions of threat, lack of consideration …

Subthreshold Ptsd And Associated Psycholgical Distress In Trauma Exposed Male And Female Veterans, Matthew A. Southard

Dissertations, Theses, and Capstone Projects

Post-Traumatic Stress Disorder (PTSD) represents the upper end of a stress-response continuum to traumatic events, rather than a discrete pathological syndrome (Ruscio, et al., 2002). Individuals with PTSD report higher levels of anxiety, depression, anger, aggression, and adjustment difficulties compared to non-traumatized individuals (Ginzburg, Ein-Dor, & Soloman, 2009; Thompson et al, 2011; Novaco and Chemtob, 2002; Kotler et al, 2001; Orth & Wieland, 2006). Subthreshold PTSD represents a less severe range on the stress-response continuum and these individuals may experience similar rates of symptoms of anger, aggression, and depression as those with full-PTSD (Jakupcak, et al., 2007; Mylle & Maes, …

Certainty About The Absence Of Positive Future Events As A Unique Predictor Of Suicidal Ideation Over An 18-Month Period, Christina A. Rombola

Theses and Dissertations

We examined the effects of two components of depressive predictive certainty, Certainty-AP and Certainty-N, on suicidal ideation over an 18-month period. We hypothesized that Certainty-AP would better predict SI than Certainty-N, and that future-event fluency would significantly moderate the Certainty-AP and SI relationship. Results and potential implications are discussed.

Multimodal Depression Detection: An Investigation Of Features And Fusion Techniques For Automated Systems, Michelle Renee Morales

Dissertations, Theses, and Capstone Projects

Depression is a serious illness that affects a large portion of the world’s population. Given the large effect it has on society, it is evident that depression is a serious health issue. This thesis evaluates, at length, how technology may aid in assessing depression. We present an in-depth investigation of features and fusion techniques for depression detection systems. We also present OpenMM: a novel tool for multimodal feature extraction. Lastly, we present novel techniques for multimodal fusion. The contributions of this work add considerably to our knowledge of depression detection systems and have the potential to improve future systems by …

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 …

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 …

When We Say 'Physician Burnout,' We Really Mean Depression, Irvin Sam Schonfeld

Publications and Research

There has been controversy regarding the extent to which burnout overlaps depression. I enumerate eight reasons explaining to why depression is at the heart of burnout. Some of these reasons pertain to the highly similar work-related causes of burnout and depression, burnout adherents' faulty categorical and dimensional conceptualizations of burnout and depression, problematically high correlations between emotional exhaustion (the core of burnout) and depressive symptoms, research on physicians and dentists that underline burnout-depression overlap, and the problem of alexithymia being similarly related to burnout and depression. Suggestions for addressing the problem of burnout-depression among physicians are presented.

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. …