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Burn Out Psychiatric impacts and psycho-social outcomes

Burn Out Psychiatric impacts and psycho-social outcomes. Professor Philippe Corten Dewell P., From L., Friedrich A., Tiv Ph, Van Driette Y., Pelc I. Clinique du Stress - 2005. Burn Out was described first by Maslach Freudenberger As a specific job stress syndrome.

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Burn Out Psychiatric impacts and psycho-social outcomes

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  1. Burn OutPsychiatric impacts and psycho-social outcomes Professor Philippe Corten Dewell P., From L., Friedrich A., Tiv Ph, Van Driette Y., Pelc I. Clinique du Stress - 2005

  2. Burn Out was described first by Maslach Freudenberger As a specific job stress syndrome Burn Out is characterized by Emotional exhaustion ( physical tiredness) Cynicism Demotivation Burn Out is Insidious Progressive (10 years) Burn Out: Background

  3. Adaptative behaviors Increase the emotional resistance To care for without self involvement To chose realistic targets Repetition => Burn Out Process To proof oneself against emotions Objectalization of the human intercourse Restriction of the ambitions Burn Out result of the repetition of adaptative behaviors toward job stress • Terminal Burn Out • Emotional exhaustion • Cynicism • Demotivation

  4. Burn Out appears particularly at work and in jobs with Vocation Contact with the public Work in teams Where relational abilities are important But The Maslach Burn Out Inventory (the most used test) can be applied only On workers who work with other people Tautology? Burn Out: Background

  5. Burn Out: Aim and hypothesis • Is Burn Out a severe disease? • Has Burn Out severe outcomes? • What are the Burn Out Characteristics? • Is Burn Out a form of depression (smiling depression)? • Is Burn out specific for some types of jobs?

  6. Design: retrospective study Sample: Source: outpatients of the “clinique du stress” CHU-Brugmann, Brussels since September 2002 to august 2005. Inclusive criteria: Step 1: all patients who met the definition of a pathological chronic stress were assessed (N= 395) Definition of a chronic pathological stress: A persistent state of tension negatively perceived Where someone is or feels unable to answer adequately to the task Where this inability may have significant consequences With psychological, physical and/or functional impact Burn Out: Methodology

  7. Inclusive criteria Step 2: Only patients who attribute the main source of stress to the job were maintained in the sample (N= 341) Step 3: Following the Maslach criteria the sample was divided in 3 subgroups Terminal Burn Out (MBI = level 8) Burn Out in process (MBI= 4 to 7) No Burn Out (MBI= 0 to 3) Step 4: statistical analysis were computed on the samples: Terminal Burn Out (N=56) Versus No Burn Out (N=55) Burn Out: Methodology

  8. Tools Clinical assessment: GHQ-28 of D. Goldberg (General Health Questionnaire) with 4 subscales Anxiety Depression Summarizations Disability Beck Depression Inventory Perceived stress of Cohen and Williamson Stress at work of Legeron Maslach Burn Out Inventory Attitudes and behaviors toward stress Locus of control Copings Assertivity Alexythymia (TAS-20) Clinical interview and follow-up by psychologists and/or psychiatrists Anamnesis data Sociologic data Treatment Drugs Psychotherapy Medical disablement to work Burn Out: Methodology

  9. Burn Out: Results 1- How Bun Out is a severe disease?

  10. Burn Out: Results 1- How Bun Out is a severe disease?

  11. Burn Out: Results 1- How Bun Out is a severe disease?

  12. Burn Out: Results1- How Bun Out is a severe disease?

  13. Burn Out: Results2- What are the outcomes?

  14. Burn Out: Results2- What are the outcomes?

  15. Burn Out: Results2- What are the outcomes?

  16. Burn Out: Results2- What are the outcomes?

  17. Locus of control Internality (0 to 6) BO=8 Mean 2,53 sd 1,63 BO=0 Mean 3,38 sd 1,51 Anova p= .005 Externality (0 to 6) BO=8 Mean 2,04 sd 1,51 BO=0 Mean 1,27 sd 1,13 Anova p=. 003 => More externalists Copings => worse copings Burn Out: Results3- Characteristics: a) Attitudes toward stress

  18. Emotions Bad perceptions (0 to 35, cutting point 14) BO=8 Mean 23,38 sd 5,87 BO=0 Mean 19,15 sd 6,46 Anova p= .003 Bad verbalizations (0 to 25, cutting point 10) BO=8 Mean 17,11 sd 3,99 BO=0 Mean 14,48 sd 4,38 Anova p= .007 Avoidance of emotions (0 to 40, cutting point 16) BO=8 Mean 16,13 sd 4,57 BO=0 Mean 14,33 sd 4,00 Anova NS => Worse perception and verbalization Assertivity More passive and less assertive Burn Out: Results3- Characteristics: a) Attitudes toward stress

  19. Burn Out: Results3- Characteristics: b) Sociological data • No differences between BO=0 and BO=8 for • Age: 42 years sd 9 • Gender: 50% male, 50% female • Life milieu: 75% founded home • Civil status: 72% married • Children: 66% • Education: 69% University of High Schools • Work: 64% employee, 25% manager

  20. Burn Out: Results3- Characteristics: c) Complaints

  21. Burn Out: Discussion1- Is Burn Out a form of depression? • But • 66% of the patients with terminal Burn Out don’t reach the cutting points of these scales for major depression • Is it due to the constructs of the scales? • GHQ: 3/7 questions on suicide • Beck: sadness preeminent • Interest to use other scales • Other dysphoric expressions? Irritability • Anhedonia • Or Burn Out is an other syndrome ? (Cynicism is not common in depressive disorders)

  22. International literature attribute Burn Out to some type of jobs characterized by Vocation Contact with the public Work in teams Where relational abilities are important Chi Square Burn Out Terminal Versus No Burn Out in process Results No significant differences Discussion Sample to little? Scale problem? Burn Out: Discussion2- Is Burn Out specific for some type of jobs?

  23. Burn Out: Discussion2- Is Burn Out specific for some types of jobs?

  24. Burn Out: Conclusions • Burn Out is a severe disorder (GHQ=21) • Outcomes • Long time follow-up (12 months) and disablement (8,5 months for 75%) • 75% with anti depressive drugs + psychotherapy and relaxation • 80% go back to the labor market but only ½ at the same job and ¼ lose their jobs • Characteristics • No sociological differences • Worse attitudes toward stress • Concentration and short memory impairments + tiredness • Is Burn Out a form of depression? • Probably no • Is Burn Out specific for some types of work? • No • But linked to work organization

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