Sick with burnout : clarified through electronic diaries

The primary aim of this thesis is to enlarge our understanding of severe or clinical burnout through an extensive study on the actual functioning in daily life of burned-out individuals. Burnout is a fairly recent but common work-related health problem. About 20% of employees suffers from mild burnout symptoms and an additional 4% from severe symptoms. The main cause of burnout is chronic stress at work, which induces a process of psychological erosion. The result is a state of severe exhaustion, with a co-occurring cynical attitude towards work and the belief that one's professional accomplishments have failed. Burnout research has concentrated on milder expressions of the syndrome in relatively healthy employees who are still working. Yet, when burnout symptoms have emerged, they seem resistant to change and the risk of sick leave increases. It is, therefore, surprising that the most severe cases on extended sick leave have been neglected in burnout research. Consequently, the exact characteristics of clinical burnout are still badly understood. This thesis seeks to extend our understanding of the symptoms of clinically burned-out employees and to enhance diagnostic clarity. To obtain a detailed account of patients' symptoms we employed an electronic diary according to the Experience Sampling Method (ESM) instead of using the common retrospective questionnaires. ESM provides more reliable and detailed information in the natural context of burned-out individuals. The current thesis showed that clinical burnout is characterized by continuous severe fatigue that is not relieved by sleep and is, at least partially, maintained by sleep disturbances. Though depressive mood is common in clinical burnout, we found new evidence that depression does not seem to complicate the syndrome and that burnout and depression are distinct syndromes. The severity of exhaustion is reflected in the physiology of the body, namely somewhat lower cortisol levels at awakening. Nevertheless, full recovery from clinical burnout is possible in the long-run: Within 10 months after sick leave 37% of our clinically burned-out employees showed recovery of complaints and had fully resumed work. These findings are, likely, highly reliable, considering that we used ESM for symptom assessment, and that the method was well accepted and adhered to by the exhausted patients. The current thesis evidently demonstrates the advantages of ESM above questionnaires, i.e. a higher reliability of measurements and the possibility of within-person studies. As for clinical practice, our results point out that persistent disturbed sleep and neglect of regular periods of recovery constitute important early warning signs of burnout development in employees who are at work. In addition, the treatment of sleep problems in burned-out individuals on extended leave of absence seems of primary importance, since they constitute a risk factor for prolonged sick leave and exhaustion. Furthermore, patient education should incorporate that full recovery from clinical burnout lies within reach of many individuals. The current thesis was only a first step, and hopes to inspire research on clinical burnout with the purpose to enhance empirical knowledge and improve clinical practice