Burnout and depression. A critical review

 Background. Traditionally, burnout and depression have been considered two independent syndromes. Burnout has been defined as a three-dimensional syndrome made up of emotional exhaustion, cynicism or depersonalization, and lack of professional efficacy or personal accomplishment. While depression has been characterized by helplessness related to a wide range of symptoms. However, the distinction between burnout and depression as independent conditions remains controversial. Aim. This study aimed to provide an up-to-date review of the literature on burnout and depression to clarify if burnout and depression are distinct or overlapping conditions. Literature review. A critical review of the most highly influential citations within the last decade was conducted using Semantic Scholar, a science search engine designed to highlight the most important and influential papers in the field using Artificial Intelligence. Results. Most influential studies failed to support the classical distinction between burnout and depression based on the following: First, the depressive nature of burnout. Emotional exhaustion, the core dimension of burnout, involves a depressed mood. Second, a lack of discriminant validity between burnout and depression. Burnout predicts, and it is predicted by, depressive symptoms. The “gold standard” for measuring burnout, the Maslach Burnout Inventory, focuses on exhaustion as a core symptom, which overlaps with fatigue and loss of energy in depression. Moreover, virtually every burnout case reports a wide range of depressive symptoms. Third, stress plays a central role in the etiology of both burnout and depression and deleterious effects in executive functions for both conditions. Furthermore, the tendency to feel stress, neuroticism, increases the risk of both, burnout and depression. Finally, no biological marker has been found for burnout or depression supporting the role of psychosocial factors. Conclusion. A critical review of the most highly influential studies up to date suggests that burnout may be better understood as a depression in response to chronically adverse working conditions. Discussion. The generalized use of burnout and depression as independent constructs may be misleading, encouraging a conceptualization of burnout as a mild form of depression, and diminishing attention towards adverse working conditions Finally, key implications for health promotion at the workplace preventing well-known adverse conditions (work overload, shift-work, role conflicts…) are further discussed in the light of social determinants of health.

Palabras clave