Burnout

Burnout has been defined as a “prolonged response to chronic interpersonal stressors on the job” that is characterized by exhaustion, cynicism, and detachment, and lack of accomplishment/ ineffectiveness from work (Maslach and Leiter, 2016). It is not simply the stress response of exhaustion but includes a deterioration in the quality of one's work with others and subsequent negative evaluation of oneself. Burnout is reflected by negative scores on all three dimensions (Leiter and Maslach, 2016). For people working in health care and human services, burnout has long been recognized as a potential risk.

But now burnout has been reported as a problem in many other occupations. Burnout is related to an increased risk for mental health problems (Leiter and Maslach, 2000) and physical health outcomes, including risk of cardiovascular disease and cardiovascular-related events (Melamed et al., 2006) as well as biological markers of neuroendocrine, immune, metabolic, and cardiovascular health (Juster et al., 2011).

Several research measures of burnout exist, and they vary in terms of what dimensions are assessed (all three or only exhaustion), and the number and response format of scale items. No clinical research has been done to establish a "cut-off score" (or "diagnosis") for dysfunctional levels of burnout. The measure of choice for new studies likely depends on the population of interest, the size of the population (shorter measures are only valid for very large samples), study hypotheses, financial limitations (e.g., licensing fees for propriety measures), study design considerations (e.g., repeated measures), and participants` time constraints.

Maslach Burnout Inventory

The original research measure of burnout and the one most commonly used is the Maslach Burnout Inventory (MBI; Maslach et al., 2017). The MBI assesses the three dimensions of the burnout experience -- exhaustion, cynicism/detachment, and professional inefficacy -- and contains either 22 items or 16 (for the General Surveys). Several MBI versions exist for different study populations -- the MBI-General Survey (which can be used for any population), the MBI-Human Services Survey, the MBI-Human Services Survey for Medical Personnel, MBI-Educators Survey, and MBI-General Survey for Students. The MBI has been translated into many languages and has been validated widely, including health care providers (Poghosyan et al., 2009; Rafferty et al., 1986). The MBI is copyrighted, and permission to reproduce it or translate it must be obtained from the publisher, Mind Garden.

 

Additional multidimensional non-proprietary burnout measures exist, differing in occupational focus and measured dimensions of burnout (reviewed in Maslach and Leiter, 2016):

  • The Bergen Burnout Inventory, 9 items (BBI; Feldt et al., 2014) measures burnout in the work context (in all occupations), assessing (1) exhaustion at work (emotional component), (2) cynicism toward the meaning of work (cognitive component), and (3) the sense of inadequacy at work (behavioral component). The 9-item BBI can be found in the paper by Salmelo-Aro and colleagues (2011).

  • The Oldenburg Burnout Inventory, 16 items (OLBI; Halbesleben and Demerouti, 2005) assesses (physical, affective, and cognitive) exhaustion and disengagement in both work and academic contexts, whereas personal accomplishment is excluded.

The English version of the original OLBI can be found here: (Demerouti et al., 2010). The OLBI has been adapted to capture academic burnout (OLBI-S). The OLBI-S English, German and Greek versions can be found in the paper by Reis and colleagues (2015).

  • The Professional Quality of Life Compassion Satisfaction and Fatigue Version 5, 30 items (ProQOL; Figley and Stamm, 1996; Stamm, 2010) scale assesses both positive and negative aspects of professional care; it is one of the most commonly used scales for frontline providers who work with stress- and trauma-exposed populations (Stamm, 2010). The ProQOL has sub-scales for burnout, compassion satisfaction and compassion fatigue/secondary traumatic stress. The ProQOL is freely available here, as long as the author is credited, no changes are made, and it is not sold.

Other burnout measures focus on exhaustion alone:

  • The 14 item Shirom-Melamed Burnout Measure (SMBM; Shirom, 1989) conceptualizes burnout as the depletion of energetic resources, distinguishing between physical fatigue, emotional exhaustion, and cognitive weariness. The SMBM can be downloaded here.

  • The Copenhagen Burnout Inventory (CBI; Kristensen et al., 2005) assesses personal burnout (6 items), work-related burnout (7 items), and client-related burnout (6 items). In the CBI, the core of burnout is physical and psychological exhaustion. The measure can be downloaded here.

  • The Burnout Measure (BM; Pines and Aronson, 1988) includes 21 items, designed to measure physical, emotional, and mental exhaustion. A shorter 10-item version is also available (see appendix in Malach-Pines, 2005).

  • A single-item measure served as a reliable substitute for the MBI exhaustion dimension across occupations (Dolan et al., 2015).

Author and Reviewer(s):

This summary was prepared by Stefanie Mayer, and reviewed by Christina Maslach and Eve Ekman. If you have any comments on these measures, email Stefanie.Mayer@ucsf.edu. Version date: January 2018

References:

Demerouti, E., Mostert, K., Bakker, A.B., 2010. Burnout and work engagement: a thorough investigation of the independency of both constructs. Journal of Occupational Health Psychology 15, 209-222.

Dolan, E.D., Mohr, D., Lempa, M., Joos, S., Fihn, S.D., Nelson, K.M., Helfrich, C.D., 2015. Using a single item to measure burnout in primary care staff: a psychometric evaluation. Journal of General Internal Medicine 30, 582-587.

Feldt, T., Rantanen, J., Hyvonen, K., Makikangas, A., Huhtala, M., Pihlajasaari, P., Kinnunen, U., 2014. The 9-item Bergen Burnout Inventory: factorial validity across organizations and measurements of longitudinal data. Industrial Health 52, 102-112.

Figley, C.R., Stamm, B.H., 1996. Psychometric review of compassion fatigue self test. Measurement of Stress, Trauma, and Adaptation, 127-130.

Halbesleben, J.B.R., Demerouti, E., 2005. The construct validity of an alternative measure of burnout: Investigating the English translation of the Oldenburg Burnout Inventory. Work Stress 19, 208-220.

Juster, R.P., Sindi, S., Marin, M.F., Perna, A., Hashemi, A., Pruessner, J.C., Lupien, S.J., 2011. A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers. Psychoneuroendocrinology 36, 797-805.

Kristensen, T.S., Borritz, M., Villadsen, E., Christensen, K.B., 2005. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 19, 192-207.

Leiter, M.P., Maslach, C., 2000. Burnout and health, In: Baum, A., Revenson, T., Singer, J. (Eds.), Handbook of Health Psychology. Hillsdale, NJ: Lawrence Erlbaum, pp. 415-426.

Leiter, M.P., Maslach, C., 2016. Latent burnout profiles: A new approach to understanding the burnout experience. Burnout Research 3, 89-100.

Malach-Pines, A., 2005. The burnout measure, short version. International Journal of Stress Management 12, 78–88.

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L., 2017. Maslach Burnout Inventory. Fourth edition. Palo Alto, CA: Mind Garden Inc.

Maslach, C., Leiter, M.P., 2016. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry 15, 103-111.

Melamed, S., Shirom, A., Toker, S., Berliner, S., Shapira, I., 2006. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychological Bulletin 132, 327-353.

Pines, A.M., Aronson, E., 1988. Career burnout. Free Press, New York.

Poghosyan, L., Aiken, L.H., Sloane, D.M., 2009. Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries. International Journal of Nursing Studies 46, 894-902.

Rafferty, J.P., Lemkau, J.P., Purdy, R.R., Rudisill, J.R., 1986. Validity of the Maslach Burnout Inventory for family practice physicians. Journal of Clinical Psychology 42, 488-492.

Reis, D., Xanthopoulou, D., Tsaousis, I., 2015. Measuring job and academic burnout with the Oldenburg Burnout Inventory (OLBI): Factorial invariance across samples and countries. Burnout Research 2, 8-18.

Salmela-Aro, K., Rantanen, J., Hyvonen, K., Tilleman, K., Feldt, T., 2011. Bergen Burnout Inventory: reliability and validity among Finnish and Estonian managers. International Archives of Occupational and Environmental Health 84, 635-645.

Shirom, A., 1989. Burnout in work organizations., In: Cooper, C.L., Robertson, I. (Eds.), International Review of Industrial and Organizational Psychology. Wiley, New York, pp. 25-48.

Stamm, B.H. (2010). The Concise ProQOL Manual. Pocatello, ID: ProQOL.org.