title: On the nature of burnout-insomnia relationships: a prospective study of employed adults.
abstract: OBJECTIVE
  This prospective study was designed to test the hypothesis that burnout and insomnia predict each other's incidence and intensification across time. Burnout is conceptualized as representing individuals' unique affective response to their exposure to chronic stressors.
  
  
  METHODS
  Apparently healthy respondents (1356) completed questionnaires during periodic health examinations undergone at two time points T(1) and T(2), about 18 months apart. Burnout was assessed by the Shirom-Melamed Burnout Measure, while insomnia was assessed by the Brief Athens Insomnia Scale. Depressive symptomatology, neuroticism, body mass index, age, gender, follow-up duration, and T(1) levels of the criterion were controlled.
  
  
  RESULTS
  Burnout and insomnia were found to be only moderately associated at T(1). However, logistic regression results indicated that burnout significantly predicted the development of new cases of insomnia at 18-month follow-up [odds ratio (OR)=1.93; 95% confidence interval (95% CI)=1.45-2.58], even after adjusting for depression and other potent confounders. Likewise, insomnia significantly predicted the onset of new cases of burnout at 18-month follow-up (OR=1.64; 95% CI=1.30-2.08). Hierarchical regression results indicted that T(1) burnout significantly predicted an increase in T(2) insomnia (beta=.05, P<.05), and that T(1) insomnia significantly predicted an increase in T(2) burnout (beta=.07, P<.05).
  
  
  CONCLUSIONS
  The results indicate that burnout and insomnia recursively predict each other's development and intensification over time, thus suggesting that either might be a risk factor for the other across time. Possible mechanisms of link between burnout and insomnia, as well as the clinical implications of the findings, were suggested.
authors.affiliation: Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Armon
authors.forename: Arie
authors.initials: A
authors.lastname: Shirom
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
authors.forename: Samuel
authors.initials: S
authors.lastname: Melamed
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D002055:Burnout, Professional / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D035061:Control Groups; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004644:Emotions; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015995:Prevalence; D011336:Probability; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires