Stress‐related exhaustion disorder – clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro‐biological and physiological changes in clinical burnout

Abstract

The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.

Plasma metabolomic patterns in patients with exhaustion disorder

“…One of the core symptoms reported by these patients is the extreme fatigue and lack of energy that has developed over months and sometimes years and clinically reported to be long lasting (Glise, Ahlborg, & Jonsdottir, 2012Grossi et al, 2015). Despite considerable efforts, no one has yet been able to pinpoint the biological mechanisms that plausibly could explain the exhaustion reported by patients with ED/clinical burnout (Danhof-Pont, van Veen, & Zitman, 2011).…”

“…The results have been contradictory and no single biomarker of stress-related illness has emerged (Danhof-Pont et al, 2011;Grossi et al, 2015;Kudielka, Bellingrath, & Hellhammer, 2006;Pruessner, Hellhammer, & Kirschbaum, 1999). Although the main symptoms of stress-related conditions are exhaustion, lack of energy, and fatigue that is no longer responsive to normal periods of rest (Sonnenschein, Sorbi, van Doornen, Schaufeli, & Maas, 2007), much less attention has been directed at elucidating metabolic processes and the ability to mobilize energy.…”

“…Stress-related conditions such as exhaustion disorder and the closely related condition clinical burnout (Grossi, Perski, Osika, & Savic, 2015) are becoming increasingly common in Sweden and other countries. One of the core symptoms reported by these patients is the extreme fatigue and lack of energy that has developed over months and sometimes years and clinically reported to be long lasting (Glise, Ahlborg, & Jonsdottir, 2012Grossi et al, 2015).…”

Association between shift work, salivary cortisol levels, stress and fatigue in nurses: integrative review

“…[9][10][11][12][13][14][15] In addition, low cortisol levels upon awakening and daytime cortisol decrease have been considered predictors of fatigue, burnout and vital exhaustion. [16][17][18] Nursing professionals, due to long working hours in assorted shifts, are specially susceptible to chronic stress and fatigue, whose consequences, on the long run, amount to desynchrony of the HHA axis and consequent physical and mental disease, work capability decrease, occupational accident increase, and absenteeism. [19][20][21][22] Considering the aforementioned, the goal of this study was to identify, in Brazilian and international literature, scientific evidence on the correlation of work in shifts and alterations to cortisol circadian rhythm, stress levels, and fatigue in nursing workers.…”

"You Can't Feel Healthier than Your Caregiver" - The Ripple Effect of Trust and Empathy for Patients and Health Care Staff, Cultivated through Cultural Activities

“…A significant portion of health care personnel report high levels of work-related stress, fatigue and mental disorders including burnout, which is the leading cause of disability and associated sick leave in Sweden [1][2][3]. For example, nurses have high rates of stress and fatigue both during their time studying and early on in their careers [4,5].…”