Burnout: absence of binding diagnostic criteria hampers prevalence estimates.

In a recent review paper, Adriaenssens et al. (2015) cluded that about 26% of emergency nurses (EN) suffer burnout and described their results as alarming. ile we applaud Adriaenssens et al.’s efforts to provide a rer picture of ill-health in EN, we think that these hors’ conclusions are weakened by a fundamental fact, ely, the absence of consensual, clinically valid gnostic criteria for burnout (Bianchi and Laurent, in ss; Weber and Jaekel-Reinhard, 2000). Trying to determine the prevalence of a condition that no binding diagnostic criteria is problematic. Indeed, ending on how researchers decide to define (cases of) nout, very different results can be obtained, and ually any kind of conclusions can be drawn regarding importance of the burnout phenomenon (for an stration of this problem, see Prins et al., 2007). Within h a context, the clinical meaning of the findings is unclear, compromising effective decision-making in terms of interventions and health policies. More than 30 years after the introduction of the burnout construct in the scientific literature (Freudenberger, 1974), Shirom (2005) pointed out that ‘‘burnout researchers should begin with a clear definition of the construct of burnout’’ (p. 268). Shirom’s (2005) observation remains relevant today. The nosological status of burnout is uncertain. Burnout is not recognized as a disorder, neither in the DSM-5, nor in the ICD-10. Moreover, a growing corpus of research suggests that burnout is a form of depression rather than a distinct type of psychopathology (Ahola et al., 2014; Bianchi and Laurent, in press; Bianchi et al., 2014; Hintsa et al., in press). The development of the burnout construct has been marked by arbitrary choices (see Schaufeli and Enzmann, 1998, p. 188), notably in the process that led to the elaboration of the Maslach Burnout Inventory (MBI), the ‘‘gold standard’’ for the measurement of burnout—the MBI has been used in 15 of the 17 studies reviewed by Adriaenssens and his colleagues. These arbitrary choices do not only concern the cutpoints that have been proposed by the developers of the MBI (as noted by Adriaenssens et al.); arbitrariness also haunts the initial selection of the items that, when submitted to a factor analysis, gave birth to the three dimensions of burnout—emotional exhaustion, depersonalization, and (reduced) personal accomplishment—(Schaufeli and Enzmann, 1998). This state of affairs undermines the MBI-related, field-dominating conceptualization and operationalization of burnout. Burnout has become popularly known. There is a worrying discrepancy, however, between this popularity and the definitional clarity of the phenomenon. In our view, priority should be given to systematic clinical observation in order to clarify the nosological status of burnout and allow researchers to propose—if justified—sound diagnostic T I C L E I N F O