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Burnout syndrome' – from nosological indeterminacy to epidemiological nonsense

Published online by Cambridge University Press:  02 January 2018

Renzo Bianchi ,
Irvin Sam Schonfeld  and
Eric Laurent
Renzo Bianchi
Affiliation:
University of Neuchâtel, Neuchâtel, Switzerland; email: renzo.bianchi@unine.ch
Irvin Sam Schonfeld
Affiliation:
The City College of the City University of New York, New York City, USA
Eric Laurent
Affiliation:
Bourgogne Franche-Comté University, Besancon, France
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Abstract

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BJPsych Bulletin , Volume 41 , Issue 6 , December 2017 , pp. 367 - 368
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Creative Common License - CCCreative Common License - BY
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © The Royal College of Psychiatrists, 2017

Imo Reference Imo1 conducted a systematic literature review of research on the prevalence of burnout among UK medical doctors, arriving at the conclusion that the prevalence of burnout in this population is ‘worryingly high’. Problematically, it turns out that such a conclusion cannot be drawn in view of the state of burnout research. Indeed, there are no clinically valid, commonly shared diagnostic criteria for burnout. Reference Bianchi, Schonfeld and Laurent2,Reference Bianchi, Schonfeld and Laurent3 Given that what constitutes a case of burnout is undefined, how could an investigator estimate the prevalence of burnout, let alone conclude that burnout is widespread? As demonstrated elsewhere, Reference Bianchi, Schonfeld and Laurent2–Reference Bianchi, Schonfeld and Laurent5 the diffuse estimates of burnout prevalence actually rely on categorisation criteria that are nosologically arbitrary and devoid of any sound theoretical justification. It is disconcerting to observe that studies of burnout prevalence continue multiplying in spite of the publication of several warnings against such research practices Reference Bianchi, Schonfeld and Laurent2–Reference Weber and Jaekel-Reinhard6

Another problem bearing on Imo's conclusions Reference Imo1 lies in the unknown representativeness (e.g. in terms of gender, age, place of residence, or family status) of the samples of UK medical doctors surveyed in burnout research. Although the author partly acknowledges this problem in the limitation section of his article, he does not seem to take full account of the consequences of such a state of affairs. This state of affairs implies that the results of the reviewed studies cannot be generalised to the population of UK medical doctors.

All in all, the review Reference Imo1 is undermined by the very research it relies on. We recommend that researchers interested in burnout start at the beginning, that is to say, by establishing a reasoned, clinically founded (differential) diagnosis for their entity of interest. As long as investigators do not complete the required groundwork for establishing a diagnosis and remain unable to distinguish a case of burnout from either a non-case or an existing disorder, conclusions regarding the prevalence of burnout will be nonsense. An immediately available solution for effectively monitoring and protecting physicians' occupational health would be to shift our focus from burnout to job-related depression. Reference Bianchi, Schonfeld and Laurent2,Reference Bianchi, Schonfeld, Vandel and Laurent7

References

1 Imo, UO. Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsych Bull 2017; 41: 197–204.CrossRefGoogle Scholar
2 Bianchi, R, Schonfeld, IS, Laurent, E. Physician burnout is better conceptualised as depression. Lancet 2017; 389: 1397–8.Google Scholar
3 Bianchi, R, Schonfeld, IS, Laurent, E. Burnout: absence of binding diagnostic criteria hampers prevalence estimates. Int J Nurs Stud 2015; 52: 789–90.Google Scholar
4 Bianchi, R, Schonfeld, IS, Laurent, E. The “burnout” construct: an inhibitor of public health action? Crit Care Med 2016; 44: e1252–3.Google Scholar
5 Bianchi, R, Schonfeld, IS, Laurent, E. The dead end of current research on burnout prevalence. J Am Coll Surg 2016; 223: 424–5.Google Scholar
6 Weber, A, Jaekel-Reinhard, A. Burnout syndrome: a disease of modern societies? Occup Med 2000; 50: 512–7.Google Scholar
7 Bianchi, R, Schonfeld, IS, Vandel, P, Laurent, E. On the depressive nature of the “burnout syndrome”: a clarification. Eur Psychiatry 2017; 41: 109–10.Google Scholar
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