Defining Physician Burnout, and Differentiating Between Burnout and Depression-I.

To the Editor: On the basis of the conclusion that more than 50% of US physicians suffer from burnout, Melnick and Powsner and Shanafelt and Noseworthy underlined the importance of taking systemic action to reduce the risk of the syndrome by improving conditions under which physicians work. To effectively deal with the issue of job stress, we think that a critical step is to understand burnout as a depressive condition. Various definitions of burnout have been proposed since the introduction of the construct in the 1970s. According to the most widely endorsed of these definitions, burnout combines emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Many studies, however, have consistently shown that the burnout syndrome, far from being reducible to its 3 definitional dimensions, actually involves the full array of “classical” depressive symptoms (eg, anhedonia, depressed mood, and suicidal ideation). For instance, in a 3-wave, 7-year study of 3255 Finnish dentists, burnout and depressive symptoms have been found to decrease/increase in parallel over time. A disattenuated correlation as high as 0.91 has been observed between burnout and depressive symptoms in a cross-sectional study of 1046 French schoolteachers that standardized the time window of the 2 entities’ assessment. The persistent neglect of these accumulating findings is problematic from both a clinical standpoint and a public health standpoint.