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Differential diagnostic of the burnout syndrome

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Author(s): Korczak, Dieter | Huber, Beate | Kister, Christine

Journal: GMS Health Technology Assessment
ISSN 1861-8863

Volume: 6;
Start page: Doc09;
Date: 2010;
Original page

Keywords: burnout | burn-out | burning out | burned out | burnout syndrom | burnout syndrome | burn-out syndrom | burnout diagnosis | burn-out diagnosis | burning out diagnosis | burned out diagnosis | burnout differential diagnosis | burn-out differential diagnosis | burning out differential diagnosis | burned out differential diagnosis | categories | burnout categories | burn-out categories | burning out categories | burned out categories | burnout symptoms | burn-out symptoms | burning out symptoms | burned out symptoms | burnout victim | burn-out victim | burning out victim | burn out outcome | burn-out outcome measure | screening | beat | drained from working conditions | MBI | Maslach Burnout Inventory | CBI | Copenhagen Burnout Inventory | SMBM | SMBQ | Shirom Melamed Burnout Measurement | Shirom Melamed Burnout Questionnaire | SBI | School Burnout Inventory | OLBI | Oldenburg Burnout Inventory | ABQ | Athlete Burnout Questionnaire | distress | exhaustion | state of exhaustion | cynicism | depersonalisation | efficiency | personal efficiency | professional efficiency | depression | alexithymia | cutoff | cut-off | comorbidity | predictors

ABSTRACT
Introduction: There is no consistent definition of burnout. It is neither a defined diagnosis in ICD-10 nor in DSM-IV. Yet it is diagnosed by office-based doctors and clinicians. Mainly due to reimbursement reasons, diagnoses like depression are used instead of burnout diagnoses. Therefore burnout has a very high individual, social and economic impact. Objectives: How is burnout diagnosed? Which criteria are relevant? How valid and reliable are the used tools? What kind of disorders in case of burnout are relevant for a differential diagnosis? What is the economic effect of a differential diagnosis for burnout? Are there any negative effects of persons with burnout on patients or clients? Can stigmatization of burnout-patients or -clients be observed? Methods: Based on a systematic literature research in 36 databases, studies in English or German language, published since 2004, concerning medical and differential diagnoses, economic impact and ethical aspects of burnout, are included and evaluated. Results: 852 studies are identified. After considering the inclusion and exclusion criteria and after reviewing the full texts, 25 medical and one ethical study are included. No economic study met the criteria.The key result of this report is that so far no standardized, general and international valid procedure exists to obtain a burnout diagnosis. At present, it is up to the physician’s discretion to diagnose burnout. The overall problem is to measure a phenomenon that is not exactly defined. The current available burnout measurements capture a three dimensional burnout construct. But the cutoff points do not conform to the standards of scientifically valid test construction. It is important to distinguish burnout from depression, alexithymia, feeling unwell and the concept of prolonged exhaustion. An intermittent relation of the constructs is possible. Furthermore, burnout goes along with various ailments like sleep disturbance. Through a derogation of work performance it can have also negative effects on significant others (for example patients). There is no evidence for stigmatization of persons with burnout. Discussion: The evidence of the majority of the studies is predominantly low. Most of the studies are descriptive and explorative. Self-assessment tools are mainly used, overall the Maslach Burnout Inventory (MBI). Objective data like medical parameters, health status, sick notes or judgements by third persons are extremely seldomly included in the studies. The sample construction is coincidental in the majority of cases, response rates are often low. Almost no longitudinal studies are available. There are insufficient results on the stability and the duration of related symptoms. The ambiguity of the burnout diagnosis is regularly neglected in the studies. Conclusions: The authors conclude, that (1) further research, particularly high-quality studies are needed, to broaden the understanding of the burnout syndrome. Equally (2) a definition of the burnout syndrome has to be found which goes beyond the published understanding of burnout and is based on common scientific consent. Furthermore, there is a need (3) for finding a standardized, international accepted and valid procedure for the differentiated diagnostics of burnout and for (4) developing a third party assessment tool for the diagnosis of burnout. Finally, (5) the economic effects and implication of burnout diagnostics on the economy, the health insurances and the patients have to be analysed.
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