The objectives of the present study were to explore the prevalence of cognitive and affective symptoms in burnout, and estimate the risk of burnout when having these symptoms in a general adult population. Although the association between emotional and cognitive factors and burnout has been established in previous research, the relationship between burnout and specific symptoms has been considerably less documented, especially in the normal population. Better understanding is also needed regarding sex-related differences in these symptoms in burnout.
The burnout group had on average a considerable higher number of CAS, and the prevalence was significantly higher in the burnout case group compared to the reference group for all specific symptoms. The most prevalent symptoms were feeling tired/lethargic, concentration difficulties, sleep disturbance, feeling depressed, and absent mindedness. The least common symptom was general discomfort. This is in line with previous literature, showing that general deficiencies such as affective disorders (46) and impairments in executive functions and cognitive coping are related to burnout (7, 18, 47). Providing more specific information, the findings from the present study indicate that each of the symptoms experiencing memory difficulties, concentration difficulties, being absent minded, feeling tired/lethargic, feeling irritable/edgy, feeling depressed, feeling worried and other cognitive and affective symptoms individually increased the risk of having burnout. Together, these cognitive and affective symptoms explained 34% of the variation in burnout. Concentration difficulties, feeling depressed and feeling tired/lethargic were the symptoms found to be strongest associated with being at risk of burnout. These findings are also in concordance with previous research on ED patients, showing that feeling tired and having sleep disturbances are reported by the majority of these patients (23), and that symptoms of depression are associated with exhaustion (30).
Regarding sex-related differences, women in the burnout case group reported significantly more symptoms than did men in that group, followed by women and then men in the reference groups, in that order. Thus, being a woman and being high in burnout were both associated with a relatively large number of CASs. This gender difference is in line with prior studies (48, 49), and may be due to differences in stress, coping style, total workload, or in reporting a body sensation being a symptom (48). The symptoms feeling tired/lethargic and sleep disturbance were, compared to the other groups, particularly common in women with burnout. Accordingly, women have been found to report more sleep disturbance and burnout compared to men (32). Regarding cognitive and affective symptoms as predictors of risk of burnout, separate analyses for men and women showed similar pattern of predictors as for the total sample, with two exceptions. Firstly, the symptom memory difficulties was a significant predictor of burnout for women but not for men and, secondly, the symptom feeling worried was a significant predictor for men, but not for women. Interestingly, sleep disturbance was not a significant predictor in the adjusted model, which in the literature is described as a common symptom of burnout (50, 51). This may be explained by sleep disturbance being a common symptom in the general populations that does not only include persons with burnout (32, 52).
Another finding was that with each additional symptom the risk of burnout increased by a factor 1.68, when controlling for background variables. This implies that if having five symptoms (which was the average number of symptoms in the burnout group), there is a 13-fold increased risk of burnout. Thus, the burden of experiencing multiple CASs appears to be strongly associated with a high risk of burnout. These results conform with previous studies showing significant associations between burnout and affective (46, 53) and cognitive symptoms (47).
Research on the process of exhaustion indicates that individuals experience symptoms such as anxiety, irritability and cognitive problems in the initial phases (30, 54). Such knowledge can be helpful in identifying early signs of exhaustion. The findings from the present study indicate that a large proportion of individuals with burnout are tired/lethargic, have concentration difficulties, are absent minded, experience sleep disturbance, and are depressed and worried.
According to Melamed and Shirom’s conceptual definition of burnout (55), the symptoms in the present study are to a high degree associated with some of the criteria for ED. Concentration and memory difficulties, irritability, disturbed sleep and feeling tired/exhausted are symptoms included as criteria of the clinical diagnosis ED (5). The findings of the present study show that each of these symptoms were associated with burnout. Although the prevalence of the symptom sleep disturbance was higher in burnout group compared to the reference group, sleep disturbance did not predict the risk of burnout in the present study. In addition, absent mindedness is a symptom that was significantly associated with burnout in the present study, however, this symptom is not specifically considered a symptom of ED. In general, the results from the present study may contribute to the knowledge of the symptomatology underlying exhaustion related disorders and might add to the understanding of the nature of the burnout condition. For example, the total burden of symptoms seems to be an important aspect to consider when assessing patients with burnout symptoms.
As burnout is a complex phenomenon, it has been proposed that tools should be designed that consider both the antecedents and physical and psychological consequences of burnout, providing a more global vision of the burnout syndrome (2). The results from the present study can contribute to such work. The cognitive and affective symptom subscale of the EHSI used in this study contains symptoms of significance that the scales used for measuring burnout and sleep disturbance do not include. For example, memory difficulties, depression, irritability, and worry were significantly associated with burnout in the present study, but are aspects not included in the SMBQ. Examining the prevalence of these symptoms can be important when screening for exhaustion and for the detection of risk factors and early signs of pathology. In line with this, a suggestion has recently been made to add an item about memory difficulties to the Cognitive weariness subscale of the SMBQ (37). The findings from the present study provide support for such an addition.
As would be expected, the burnout case group differed significantly from the reference group with respect to demographic and health-related variables. Women reported in general higher levels of burnout than did men. Having children under the age of seven living at home as well as living without a partner was also more common for those high on burnout. The burnout group was also less engaged in physical activity, and more likely rated their health as “fairly good/poor”. In addition, it scored higher on measures of depression, anxiety, and sleep disturbance, and the prevalence of lifetime psychiatric diagnoses in that group was higher. This corresponds to previous findings regarding psychiatric comorbidity with the condition (20, 23, 56).
The strengths of the present study include the large, population-based sample, stratified for age and sex, with an age and sex distribution that is very similar to that of Sweden in general, which enhances the generalizability of the results. There are also some limitations that need to be considered. One limitation is the response rate of 40%, which might have resulted in a selection bias. For example, individuals suffering from burnout might have been less likely to participate in an extensive survey as the Västerbotten Environmental Health Study due to their exhaustion-related problems. If this is the case, the actual prevalence of CASs and burnout in the Swedish population may therefore be higher than reported in this study. However, effects of low response rate have been shown to vary very little between rates of 30–70% (57).
The quite frequent reporting of “other cognitive or affective symptoms” implies that future research should investigate an even a wider range of cognitive and affective symptoms. This could involve examining cognitive and affective symptoms as two separate scales, as their individual contribution to the condition might differ.