Is it Time to Characterize Burnout as a Depressive Syndrome? A Review of Recent Research

Abstract

Introduction

More than 40 years after the introduction of the construct in the literature, the status of “burnout” remains unclear. Whether burnout is anything other than a depressive syndrome has been increasingly discussed in recent years.

Objectives

We examined the extent to which burnout can be considered distinct from depression.

Methods

We reviewed the literature dedicated to burnout-depression overlap over the last decade.

Results

Recent research suggests that burnout and depression overlap in terms of (a) etiology, with (chronic) unresolvable stress a common, key causal factor, (b) clinical picture and course, with burnout and depressive manifestations inextricably linked such that they increase or decrease together over time, (c) cognitive biases, with burnout and depressive symptoms similarly predicting increased attention to negative stimuli and decreased attention to positive stimuli, (d) dispositional correlates (e.g, neuroticism, rumination, pessimism), and (e) allostatic load—an index of the biological cost of adaptation to life adversity. Hypocortisolism has been linked to both burnout and depression with atypical features—a highly prevalent form of depression. The often-invoked argument that burnout is singularized by its job-related character is actually invalid given that (a) depression can also be job-related and (b) the “job-relatedness” of a syndrome is not nosologically discriminant in itself.

Conclusions

Robust evidence that burnout overlaps with depression has accumulated in recent years. The burnout construct is unlikely to capture a distinct pathological phenomenon. We propose that burnout be characterized as a depressive syndrome for the sake of conceptual parsimony, theoretical clarity, and effective public health policies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.