Skip to main content
Article

Burnout of the Mind – Burnout of the Body?

Published Online:https://doi.org/10.1027/0269-8803/a000182

Abstract. In the present paper we investigate whether patients with a clinical diagnosis of burnout show physiological signs of burden across multiple physiological systems referred to as allostatic load (AL). Measures of the sympathetic-adrenergic-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis were assessed. We examined patients who had been diagnosed with burnout by their physicians (n = 32) and were also identified as burnout patients based on their score in the Maslach Burnout Inventory-General Survey (MBI-GS) and compared them with a nonclinical control group (n = 19) with regard to indicators of allostatic load (i.e., ambulatory ECG, nocturnal urinary catecholamines, salivary morning cortisol secretion, blood pressure, and waist-to-hip ratio [WHR]). Contrary to expectations, a higher AL index suggesting elevated load in several of the parameters of the HPA and SAM axes was found in the control group but not in the burnout group. The control group showed higher norepinephrine values, higher blood pressure, higher WHR, higher sympathovagal balance, and lower percentage of cortisol increase within the first hour after awakening as compared to the patient group. Burnout was not associated with AL. Results seem to indicate a discrepancy between self-reported burnout symptoms and psychobiological load.

References

  • Bakker, A. B., Emmerik, H. V. & Euwema, M. C. (2006). Crossover of burnout and engagement in work teams. Work and Occupations, 33, 464–489. doi: 10.1177/0730888406291310 First citation in articleCrossrefGoogle Scholar

  • Bellingrath, S., Weigl, T. & Kudielka, B. M. (2009). Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers. Stress, 12, 37–48. doi: 10.1080/10253890802042041 First citation in articleCrossrefGoogle Scholar

  • Burisch, M. (1989). Das Burnout-Syndrom. Theorie der inneren Erschöpfung. Habilitationsschrift [The burnout syndrom. Theory of inner exhaustion. Postdoctoral thesis]. Berlin, Germany: Univ. Hamburg. Springer. First citation in articleCrossrefGoogle Scholar

  • Chida, Y. & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis. Biological Psychology, 80, 265–278. First citation in articleCrossrefGoogle Scholar

  • Clow, A., Thorn, L., Evans, P. & Hucklebridge, F. (2004). The awakening cortisol response: Methodological issues and significance. Stress, 7, 29–37. doi: 10.1080/10253890410001667205 First citation in articleCrossrefGoogle Scholar

  • Danhof-Pont, M. B., van Veen, T. & Zitman, F. G. (2011). Biomarkers in burnout: A systematic review. Journal of Psychosomatic Research, 70, 505–524. doi: 10.1016/j.jpsychores.2010.10.012 First citation in articleCrossrefGoogle Scholar

  • De Vente, W., Olff, M., Van Amsterdam, J., Kamphuis, J. & Emmelkamp, P. M. G. (2003). Physiological differences between burnout patients and healthy controls: Blood pressure, heart rate, and cortisol responses. Occupational and Environmental Medicine, 60(Suppl 1), i54–i61. doi: 10.1136/oem.60.suppl_1.i54 First citation in articleCrossrefGoogle Scholar

  • Dienstbier, R. A. (1989). Arousal and physiological toughness: Implications for mental and physical health. Psychological Review, 96, 84–100. doi: 10.1037/0033-295X.96.1.84 First citation in articleCrossrefGoogle Scholar

  • Frankenhaeuser, M. (1989). A biopsychosocial approach to work life issues. International Journal of Health Services: Planning, Administration, Evaluation, 19(4), 747–758. First citation in articleCrossrefGoogle Scholar

  • Frankenhaeuser, M. (1991). The psychophysiology of workload, stress, and health: Comparison between the sexes. Annals of Behavioral Medicine, 13, 197–204. First citation in articleGoogle Scholar

  • Fredrikson, M., Tuomisto, M., Lundberg, U. & Melin, B. (1990). Blood pressure in healthy men and women under laboratory and naturalistic conditions. Journal of Psychosomatic Research, 34, 675–686. First citation in articleCrossrefGoogle Scholar

  • Grote, T. (2009). Schlaferholung und Herzratenvariabilität als Indikatoren für Wohlbefinden und Gesundheit. Ergebnisse zur aktuellen Schlaferholung im Kontext von Schlafdauer, Schlafdefizit, Beanspruchung, Wohlbefinden und kardial-vegetativen Regulationskennwerten der Herzratenvariabilität bei nicht schlafgestörten Erwachsenen (Dissertation) [Sleep recovery and heart rate variability as indicators of well-being and health: Results for current sleep recovery in context of sleep duration, sleep deprivation, stress, wellbeing and cardiac-vegetative regulation parameters of heart rate variability at adults without insomnia]. Graz, Austria: Karl-Franzens-Universität Graz. First citation in articleGoogle Scholar

  • Halbesleben, J. & Buckley, M. R. (2004). Burnout in organizational life. Journal of Management, 30, 859–879. doi: 10.1016/j.jm.2004.06.004 First citation in articleCrossrefGoogle Scholar

  • Henry, J. P. (1992). Biological basis of the stress response. Integrative Physiological and Behavioral Science, 27, 66–83. doi: 10.1007/BF02691093 First citation in articleCrossrefGoogle Scholar

  • Juster, R.-P., Sindi, S., Marin, M.-F., Perna, A., Hashemi, A., Pruessner, J. C. & Lupien, S. J. (2011). A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers. Psychoneuroendocrinology, 36, 797–805. doi: 10.1016/j.psyneuen.2010.11.001 First citation in articleCrossrefGoogle Scholar

  • Karlamangla, A. S., Singer, B. H., McEwen, B. S., Rowe, J. W. & Seeman, T. E. (2002). Allostatic load as a predictor of functional decline. Journal of Clinical Epidemiology, 55, 696–710. doi: 10.1016/S0895-4356(02)00399-2 First citation in articleCrossrefGoogle Scholar

  • Kawakami, N., Haratani, T. & Araki, S. (1998). Job strain and arterial blood pressure, serum cholesterol, and smoking as risk factors for coronary heart disease in Japan. International Archives of Occupational and Environmental Health, 71, 429–432. First citation in articleCrossrefGoogle Scholar

  • Kirschbaum, C. & Hellhammer, D. H. (1989). Salivary cortisol in psychobiological research: An overview. Neuropsychobiology, 22, 150–169. First citation in articleCrossrefGoogle Scholar

  • Lackner, H. K., Goswami, N., Hinghofer-Szalkay, H., Papousek, I., Scharfetter, H., Furlan, R. & Schwaberger, G. (2010). Effects of stimuli on cardiovascular reactivity occurring at regular intervals during mental stress. Journal of Psychophysiology, 24, 48–60. doi: 10.1027/0269-8803/a000006 First citation in articleLinkGoogle Scholar

  • Lackner, H. K., Goswami, N., Papousek, I., Roessler, A., Grasser, E. K., Montani, J.-P., … Hinghofer-Szalkay, H. (2010). Time course of cardiovascular responses induced by mental and orthostatic challenges. International Journal of Psychophysiology, 75, 48–53. doi: 10.1016/j.ijpsycho.2009.11.003 First citation in articleCrossrefGoogle Scholar

  • Lanfranchi, P. A. & Somers, V. K. (2002). Arterial baroreflex function and cardiovascular variability: Interactions and implications. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 283, R815–R826. doi: 10.1152/ajpregu.00051.2002 First citation in articleCrossrefGoogle Scholar

  • Langelaan, S., Bakker, A. B., Schaufeli, W. B., van Rhenen, W. & van Doornen, L. J. P. (2007). Is burnout related to allostatic load? International Journal of Behavioral Medicine, 14, 213–221. doi: 10.1007/BF03002995 First citation in articleCrossrefGoogle Scholar

  • Laudat, M. H., Cerdas, S., Fournier, C., Guiban, D., Guilhaume, B. & Luton, J. P. (1988). Salivary cortisol measurement: A practical approach to assess pituitary-adrenal function. The Journal of Clinical Endocrinology and Metabolism, 66, 343–348. doi: 10.1210/jcem-66-2-343 First citation in articleCrossrefGoogle Scholar

  • Malliani, A., Pagani, M., Lombardi, F. & Cerutti, S. (1991). Cardiovascular neural regulation explored in the frequency domain. Circulation, 84, 482–492. doi: 10.1161/01.CIR.84.2.482 First citation in articleCrossrefGoogle Scholar

  • Malpas, S. C. (2002). Neural influences on cardiovascular variability: Possibilities and pitfalls. American Journal of Physiology. Heart and Circulatory Physiology, 282, H6–H20. First citation in articleCrossrefGoogle Scholar

  • Marchand, A., Juster, R.-P., Durand, P. & Lupien, S. J. (2014). Burnout symptom sub-types and cortisol profiles: What’s burning most? Psychoneuroendocrinology, 40, 27–36. doi: 10.1016/j.psyneuen.2013.10.011 First citation in articleCrossrefGoogle Scholar

  • Maslach, C., Jackson, S. E. & Leiter, M. P. (1996). Maslach Burnout Inventory manual. Mountain View, CA: CCP, Inc. First citation in articleGoogle Scholar

  • Maslach, C., Leiter, M. P. & Schaufeli, W. (2008). Measuring burnout. In C. L. CooperS. CartwrightEds., The Oxford handbook of organizational wellbeing (pp. 86–108). Oxford, UK: Oxford University Press. First citation in articleGoogle Scholar

  • Maslach, C., Schaufeli, W. B. & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. doi: 10.1146/annurev.psych.52.1.397 First citation in articleCrossrefGoogle Scholar

  • Mauss, D., Li, J., Schmidt, B., Angerer, P. & Jarczok, M. N. (2015). Measuring allostatic load in the workforce: A systematic review. Industrial Health, 53, 5–20. doi: 10.2486/indhealth.2014-0122 First citation in articleCrossrefGoogle Scholar

  • McEwen, B. S. (1993). Stress and the individual. Mechanisms leading to disease. Archives of Internal Medicine, 153, 2093–2101. doi: 10.1001/archinte.153.18.2093 First citation in articleCrossrefGoogle Scholar

  • McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33–44. doi: 10.1111/j.1749-6632.1998.tb09546.x First citation in articleCrossrefGoogle Scholar

  • Meijman, T. F., Mulders, H. P. & van Kompier, M. A. (1990). Individual differences in adrenaline/noradrenaline reactivity and self-perceived health status. Zeitschrift für die Gesamte Hygiene und ihre Grenzgebiete, 36, 413–414. First citation in articleGoogle Scholar

  • Melamed, S., Ugarten, U., Shirom, A., Kahana, L., Lerman, Y. & Froom, P. (1999). Chronic burnout, somatic arousal and elevated salivary cortisol levels. Journal of Psychosomatic Research, 46, 591–598. doi: 10.1016/S0022-3999(99)00007-0 First citation in articleCrossrefGoogle Scholar

  • Mommersteeg, P. M. (2006). The psychophysiology of burnout. Enschede, Netherlands: Febo druk B.V.. First citation in articleGoogle Scholar

  • Montano, N., Porta, A., Cogliati, C., Costantino, G., Tobaldini, E., Casali, K. R. & Iellamo, F. (2009). Heart rate variability explored in the frequency domain: A tool to investigate the link between heart and behavior. Neuroscience and Biobehavioral Reviews, 33, 71–80. doi: 10.1016/j.neubiorev.2008.07.006 First citation in articleCrossrefGoogle Scholar

  • Munoz, M. L., van Roon, A., Riesel, H., Thio, C. & Oostenbroek, E. (2015). Validity of (ultra-)short recordings for heart rate variability measurements. PLoS One, 10, e0138921. doi: 10.1371/journal.pone.0138921 First citation in articleCrossrefGoogle Scholar

  • Ockenfels, M. C., Porter, L., Smyth, J., Kirschbaum, C., Hellhammer, D. H. & Stone, A. A. (1995). Effect of chronic stress associated with unemployment on salivary cortisol: Overall cortisol levels, diurnal rhythm, and acute stress reactivity. Psychosomatic Medicine, 57, 460–467. First citation in articleCrossrefGoogle Scholar

  • Peters, M. L., Godaert, G. L., Ballieux, R. E., van Vliet, M., Willemsen, J. J., Sweep, F. C. & Heijnen, C. J. (1998). Cardiovascular and endocrine responses to experimental stress: Effects of mental effort and controllability. Psychoneuroendocrinology, 23, 1–17. First citation in articleCrossrefGoogle Scholar

  • Pruessner, J. C., Hellhammer, D. H. & Kirschbaum, C. (1999). Burnout, perceived stress, and cortisol responses to awakening. Psychosomatic Medicine, 61, 197–204. First citation in articleCrossrefGoogle Scholar

  • Pruessner, J. C., Wolf, O. T., Hellhammer, D. H., Buske-Kirschbaum, A., von Auer, K., Jobst, S., … Pruessner, J. (1997). Free cortisol levels after awakening: A reliable biological marker for the assessment of adrenocortical activity. Life Sciences, 61, 2539–2549. doi: 10.1016/S0024-3205(97)01008-4 First citation in articleCrossrefGoogle Scholar

  • Reyes del Paso, G. A., Langewitz, W., Mulder, L. J. M., van Roon, A. & Duschek, S. (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: A review with emphasis on a reanalysis of previous studies. Psychophysiology, 50, 477–487. doi: 10.1111/psyp.12027 First citation in articleCrossrefGoogle Scholar

  • Rosch, P. J. (2001). The quandary of job stress compensation. Health and Stress, 3, 1–4. First citation in articleGoogle Scholar

  • Schaufeli, W. B., Leiter, M. P. & Maslach, C. (2009). Burnout: 35 years of research and practice. Career Development International, 14, 204–220. doi: 10.1108/13620430910966406 First citation in articleCrossrefGoogle Scholar

  • Schaufeli, W. B., Leitner, M. P., Maslach, C. & Jackson, S. E. (1996). Maslach Burnout Inventory-General Survey (MBI-GS). In C. MaslachS. E. JacksonM. P. LeiterEds., The Maslach Burnout Inventory: Test Manual (pp. 19–26). Palo Alto, CA: Consulting Psychologists Press. First citation in articleGoogle Scholar

  • Schaufeli, W. B. & van Dierendonck, D. (2000). UBOS Utrecht Burnout Scale: Manual. Amsterdam, The Netherlands: Swets Test Publishers. First citation in articleGoogle Scholar

  • Schnorpfeil, P., Noll, A., Schulze, R., Ehlert, U., Frey, K. & Fischer, J. E. (2003). Allostatic load and work conditions. Social Science & Medicine, 57(4), 647. First citation in articleCrossrefGoogle Scholar

  • Schulkin, J. (2004). Allostasis, homeostasis, and the costs of physiological adaptation. New York, NY: Cambridge University Press. First citation in articleCrossrefGoogle Scholar

  • Seeman, T. E., Crimmins, E., Huang, M.-H., Singer, B., Bucur, A., Gruenewald, T., … Reuben, D. B. (2004). Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging. Social Science & Medicine, 58, 1985–1997. doi: 10.1016/S0277-9536(03)00402-7 First citation in articleCrossrefGoogle Scholar

  • Seeman, T. E., McEwen, B. S., Rowe, J. W. & Singer, B. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences, 98, 4770–4775. doi: 10.1073/pnas.081072698 First citation in articleCrossrefGoogle Scholar

  • Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I. & McEwen, B. S. (1997). Price of adaptation – Allostatic load and its health consequences MacArthur studies of successful aging. Archives of Internal Medicine, 157, 2259–2268. First citation in articleCrossrefGoogle Scholar

  • Shirom, A., Melamed, S. & Toker, S. (2005). Burnout and health review. Current knowledge and future research direction. In J. P. HodgkinsonJ. K. FordEds., International Review of Industrial and Organizational Psychology (pp. 24–33). Chichester, UK: Wiley. First citation in articleGoogle Scholar

  • Sjörs, A., Jansson, P.-A., Eriksson, J. W. & Jonsdottir, I. H. (2012). Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population. Stress, 16. doi: 10.3109/10253890.2012.688082 First citation in articleCrossrefGoogle Scholar

  • Sluiter, J. K. (2000). Reactivity and recovery from different types of work measured by catecholamines and cortisol: A systematic literature overview. Occupational and Environmental Medicine, 57, 298–315. doi: 10.1136/oem.57.5.298 First citation in articleCrossrefGoogle Scholar

  • Stalder, T., Kirschbaum, C., Kudielka, B. M., Adam, E. K., Pruessner, J. C., Wüst, S., … Clow, A. (2016). Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology, 63, 414–432. doi: 10.1016/j.psyneuen.2015.10.010 First citation in articleCrossrefGoogle Scholar

  • Steptoe, A., Cropley, M., Griffith, J. & Kirschbaum, C. (2000). Job strain and anger expression predict early morning elevations in salivary cortisol. Psychosomatic Medicine, 62, 286–292. First citation in articleCrossrefGoogle Scholar

  • Steptoe, A., Cropley, M. & Joekes, K. (1999). Job strain, blood pressure and response to uncontrollable stress. Journal of Hypertension, 17, 193–200. First citation in articleCrossrefGoogle Scholar

  • Steptoe, A., Roy, M. P. & Evans, P. O. (1996). Psychosocial influence on ambulatory blood pressure over working and nonworking days. Journal of Psychophysiology, 10, 218–227. First citation in articleGoogle Scholar

  • Steptoe, A., Wardle, J., Lipsey, Z., Mills, R., Oliver, G., Jarvis, M. & Kirschbaum, C. (1998). A longitudinal study of work load and variations in psychological well-being, cortisol, smoking, and alcohol consumption. Annals of Behavioral Medicine, 20, 84–91. First citation in articleCrossrefGoogle Scholar

  • van Amelsvoort, L. (2001). Changes in frequency of premature complexes and heart rate variability related to shift work. Occupational and Environmental Medicine, 58, 678–681. doi: 10.1136/oem.58.10.678 First citation in articleCrossrefGoogle Scholar

  • World Medical Association (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191–2194. doi: 10.1001/jama.2013.281053 First citation in articleCrossrefGoogle Scholar

  • Wüst, S., Federenko, I., Hellhammer, D. H. & Kirschbaum, C. (2000). Genetic factors, perceived chronic stress, and the free cortisol response to awakening. Psychoneuroendocrinology, 25, 707–720. First citation in articleCrossrefGoogle Scholar

  • Wüst, S., Wolf, J., Hellhammer, D. H., Federenko, I., Schommer, N. & Kirschbaum, C. (2000). The cortisol awakening response – Normal values and confounds. Noise Health, 2, 79–88. First citation in articleGoogle Scholar

  • Zygmunt, A. & Stanczyk, J. (2010). Methods of evaluation of autonomic nervous system function. Archives of Medical Science, 6, 11–18. doi: 10.5114/aoms.2010.13500 First citation in articleCrossrefGoogle Scholar