Biological research on burnout-depression overlap: Long-standing limitations and on-going reflections

Abstract

In this commentary, we discuss seldom-noticed methodological problems affecting biological research on burnout and depression and make recommendations to overcome the limitations of past studies conducted in this area. First, we suggest that identified subtypes of depression (e.g., depression with melancholic features and depression with atypical features) should be taken into account in future biological research on burnout and depression, given that different subtypes of depression have been associated with distinct autonomic and neuroendocrine profiles. Second, we underline that research on burnout-depression overlap is made difficult by the absence of a consensual conceptualization and operationalization of burnout. In order to resolve this problem, we draw researchers' attention to the urgency of establishing a commonly shared, clinically valid diagnosis for burnout. Finally, we question the possibility of identifying a biological signature for burnout in light of global research on burnout-depression overlap.

Overlap of burnout-depression symptoms among Chinese neurology graduate students in a national cross-sectional study

“…Additionally, burnout is limited to work-related situations, while depression is more general [ 33 ]. On the other hand, some researchers suggest that burnout is a state of depression rather than an independent entity [ 34 ]. Furthermore, some studies suggest that evidence for the validity of the difference between burnout and depression is weak, and that burnout may reflect a “classic” depression process [ 35 ].…”

Burnout and Wellness: The Anesthesiologist’s Perspective

“…The physiological response to stress involves characteristic neuroendocrine pathways. 5-8 Specifically, there is an association between dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, exposure to stress, and the likelihood of developing neuropsychiatric illnesses. 9 The HPA axis is the primary means through which humans mediate the response to stress.…”

“…16 Furthermore, biological research on the link between burnout and depression (and research on burnout in general) has historically been complicated by the use of multiple definitions and the lack of uniform diagnostic criteria. 6 The inclusion of burnout into the ICD-11 will hopefully improve the accuracy of clinical identification, focus research efforts, and advance the development of efficacious treatment strategies.…”

Psychophysiological Characteristics of Burnout Syndrome: Resting-State EEG Analysis

“…The first studies on burnout were related to work and organizational psychology [1, 6–8], but further research on burnout syndrome is also relevant to clinical psychology [9–14], neuropsychology [15, 16], neurophysiology [17–19], and neuroscience [20–27]. It seems that burnout syndrome has become a popular research area for three reasons: (1) its prevalence in the general population of employees; (2) significant individual and organizational consequences; and (3) important scientific dispute on its etiology and the symptomatic characteristics that differentiate it from other diseases, especially from depression [9, 28]. Regarding methodology in burnout studies, objective methods and research outcomes are particularly needed to answer the question of whether severe burnout syndrome may be a separate entity, or whether it is a form of depression or anxiety-depression disorder induced by long-term work-related stress.…”

“…Regarding the overlapping effects with depression [10, 28–30, 42], it is particularly interesting to analyze frontal alpha asymmetry (FAA) in burnout. In depression, frontal alpha (8–13 Hz) asymmetry with hypoactivity in the frontal lobe has been reported in many findings [43–45], so FAA may also be observed in burnout groups.…”