Source: The European Agency for Safety and Health at Work (EU-OSHA)

Burnout is a serious problem that is brought on by the negative effects of chronic, work-related stress. Actual statistics are difficult to come by, but studies from the Nordic countries recently indicated that there, the prevalence of severe burnout is between 2-7 %. If these numbers are extrapolated Europe-wide, the problem and its effects on individuals, businesses and the European economy is sobering. This is why the Healthy Workplaces Manage Stress campaign aims to promote prevention and reduce the psychosocial risks that lead to stress and burnout.

Burnout can manifest itself through the experience of exhaustion, disengagement towards the job and a diminished sense of accomplishment or pride in the work. Other symptoms can include poor concentration, insomnia, anxiety, and cynicism or a break-down in relations with colleagues. Possible behavioural changes include carelessness, bad time keeping and even aggressiveness.

Burnout impacts very negatively on an employee’s mental and psychical health. Studies show that it may cause or contribute to depression, cardiovascular diseases and musculoskeletal problems. At the same time it usually goes along with absenteeism, poor performance, and/or presenteeism – thereby also damaging an organisation’s performance, reputation and bottom line.

The interventions on burnout must be targeted towards both the workplace and the suffering worker. The workplace-level actions include modifications in the working conditions, work organisation and demands. Employers are encouraged to take burnout seriously and take measures to prevent it by addressing psychosocial risks and stress in their workplaces. They can start by carrying out risk assessments and putting plans and measures into place to tackle stress before it gets out of hand. Management should promote an anti-stress culture at work from the top down. Working together with staff and listening to their concerns is also essential.

Burnout is widely understood as a multidimensional syndrome. According to the original definition, burnout manifests itself by symptoms of exhaustion, cynicism, and diminished professional efficacy.

• Exhaustion refers to feelings of overstrain, tiredness, and fatigue, which result from long-term involvement in an over-demanding work situation.
• Cynicism reflects an indifferent and distant attitude towards work, disengagement, and a lack of enthusiasm for work. It is a dysfunctional way of coping with exhausting situations, reducing the possibilities of finding creative solutions at work.
• Professional efficacy consists of feelings of competence, successful achievement, and accomplishment in one's work, which diminishes as burnout develops.

Prevalence and cost of burnout

There is no detailed information on the costs of burnout. Based on studies of its individual and organisational consequences (i.e., performance deficits, health problems, and work disability), burnout can be indirectly linked to economic losses. The yearly cost of work stress, an antecedent of burnout, was estimated to be €1,768 per worker in the Netherlands. This amount was attributable to prevention and work-related illnesses. In the United Kingdom, 10 million working days were lost due to anxiety, depression, and stress caused by work. Additionally, stress-related illnesses cost France between € 830 and €1,656. In the U.S. labour force, workers who experienced context-free fatigue, which resembles the exhaustion dimension of burnout, experienced a loss in work time due to ill health. The cost of this was estimated at $136 billion annually, an excess of $101 billion compared to workers without fatigue.

Work factors and burnout

With regard to unfavourable work conditions it has been suggested that, occupational burnout can result from a combination of high demands and low resources at work. Job demands refer to the physical, psychological, social, and organisational aspects of the work that require sustained effort. Excessive job demands and sustained effort over a prolonged period of time have been found to be associated with physiological and psychological costs for the individual. Job resources refer to those beneficial aspects of the job that help individuals achieve work goals, reduce the associated costs, and to stimulate learning and professional development. According to longitudinal studies, the psychosocial work characteristics which typically precede burnout are high quantitative and qualitative work load, role conflict and ambiguity, low predictability, experienced unfairness, and lack of participation and social support.

Burnout and work performance

According to a summary based on several studies, severe burnout is moderately related to low rated work performance. Interestingly, the relationship between burnout and work performance was consistently stronger when performance was rated by others, rather than by the employee in question. This indicates that those who suffer from burnout may not be fully aware of the extent to which burnout affects their work behaviour. In addition, the association of burnout with performance related to general contextual activities at work, which may be discretionary, was stronger than the association between burnout and performance related to the main task-related duties. This indicates that employees with burnout try to the bitter end to maintain focus on taking care of their core tasks.

Burnout and work ability

Both temporary work disability (indicated by sickness absence) and chronic work disability (indicated by disability pension) may follow burnout. Burnout has been shown to predict sickness absences. A higher level of burnout was related to a greater number of medically certified absence spells during a three-year follow-up in a multi-national pulp and paper industry organization. Additionally, burnout was related to longer company-registered absence duration during a one-year follow-up in a nutrition production organization. In the former study, burnout increased future absences, which were granted for mental disorders and diseases of the musculoskeletal and circulatory systems. A significant association has also been found between a high level of burnout and self-certified sickness absence during a three-year follow-up period among human service workers.

In a Finnish population level study, burnout was associated with medically certified sickness absence independent of prevalent mental disorders and physical illnesses. The duration of absence over two years was an excess of 55 sickness absence days in men, and 41 days in women Burnout also predicted chronic work disability over four years in the same population-based sample. This association was independent of the employees' health status at the beginning of the study. The disability pension granted to those with burnout was most often awarded on the basis of mental and behavioural disorders, and diseases of the musculoskeletal system in this Finnish sample.

Various interventions to tackle burnout (presented in Table 2) may be grouped according to either their purpose (i.e., ranging from the recognition and prevention of burnout to its treatment and rehabilitation) or their focus (i.e., the individual, the organization, or the interface between the individual and the organization). This schema replicates that widely used to described intervention for work stress. Primary prevention is aimed at all employees, while secondary prevention is aimed at those known or identified to be at risk for burnout. Individually focussed interventions aim at strengthening the individual's resources by providing better coping skills, while organisation-focussed interventions aim at changing the situation at work. Those interventions, which focus on the individual-organisational interface, concentrate on tackling the interrelationship between the employee and his or her work situation.

The approaches to alleviating burnout deal with the same issues as those measures aimed at its prevention. In guidelines for occupational health practitioners, treatment suggestions for stress-related conditions have included a change or a reorganization of the work situation, in combination with rehabilitation and retraining, psychotherapy and other forms of counselling, as well as pharmacological treatment depending on the type and severity of the symptoms. It is noteworthy that mere individually focused help is not considered sufficient. A change in the working conditions, where burnout had developed, was also included in the successful process of recovery from burnout discovered in a qualitative study of 20 employees who had suffered from severe burnout.

This recovery process included six phases as follows:

• admitting the problem,

• distancing from work,

• restoring health (both tension reduction and enjoyment),

• questioning values (both giving up the old and obtaining new ones),

• exploring work possibilities, and

• effecting a change.

The phase number four, questioning values, was described as being the most difficult while phase five, exploring work possibilities, lasted the longest.