The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants completed the exhaustion subscale of the Maslach burnout inventory and kept an electronic diary for 2 weeks to assess momentary exhaustion and daily recovery through sleep. On 3 consecutive weekdays within the diary period, saliva was sampled to determine the cortisol awakening response (CAR), levels of dehydroepiandrosterone-sulphate (DHEAS) on the first 2 weekdays, and to conduct the dexamethasone suppression test (DST) on the third weekday. We found significant relationships between endocrine values and general momentary symptom severity as assessed with the diary, but not with the retrospective questionnaire-assessed burnout symptoms. Simultaneous assessments of endocrine values and burnout symptoms assessed with the diary after awakening rendered significant associations between persons, and a trend within persons. More severe burnout symptoms were consistently associated with a lower level and smaller increase of CAR, higher DHEAS levels, smaller cortisol/DHEAS ratios and a stronger suppression after DST. Burnout symptoms were significantly related to endocrine functioning in clinical burnout under the best possible conditions of symptom measurement. This adds support to the view that severity of burnout symptoms is associated with HPA-axis functioning.

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Flow experience is a state of mind in which one is totally absorbed in a task. This study explored the daily flow patterns related to working and non-working tasks among healthy and non-healthy (burned-out) individuals using the Experience Sampling Method. The main aim of this study was to explore flow throughout the day using an operationalization that focused on the flow experience itself, as indicated by enjoyment and absorption. Forty healthy participants and 60 burned-out individuals kept an electronic diary on activities (work/nonwork), and levels of flow (enjoyment and absorption) for 14 days. Entries were prompted by a signal on average five times a day, thus rendering 5,455 entries. A curvilinear daily flow pattern was observed, with lower levels of flow during working hours. Differences were found between the components of flow: enjoyment was higher during non-working tasks, whereas absorption was higher when working. There were no differences in flow patterns between the healthy and burned-out group although the actual levels differed with the former experiencing more flow than the latter. The results confirm the validity of this means of measuring flow, using enjoyment and absorption as indicators.[188 words]

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Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion with those of healthy individuals. Sixty clinically burned-out and 40 healthy participants kept an electronic diary for 14 days, 7 times a day, yielding a total of 8,116 diary entries. This study shows that burned-out individuals typically suffer continuously from a severe fatigue throughout the day. The resulting flattened diurnal cycles mark a stable exhaustion that is uncommon in healthy persons. The current results provide novel support for the existence of severe energy erosion in clinical burnout.