title: Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study.
abstract: OBJECTIVE
  Burnout, a psychological consequence of prolonged work stress, has been shown to coexist with physical and mental disorders. The aim of this study was to investigate whether burnout is related to all-cause mortality among employees.
  
  
  METHODS
  In 1996, of 15,466 Finnish forest industry employees, 9705 participated in the 'Still Working' study and 8371 were subsequently identified from the National Population Register. Those who had been treated in a hospital for the most common causes of death prior to the assessment of burnout were excluded on the basis of the Hospital Discharge Register, resulting in a final study population of 7396 people. Burnout was measured using the Maslach Burnout Inventory-General Survey. Dates of death from 1996 to 2006 were extracted from the National Mortality Register. Mortality was predicted with Cox hazard regression models, controlling for baseline sociodemographic factors and register-based health status according to entitled medical reimbursement and prescribed medication for mental health problems, cardiac risk factors, and pain problems.
  
  
  RESULTS
  During the 10-year 10-month follow-up, a total of 199 employees had died. The risk of mortality per one-unit increase in burnout was 35% higher (95% CI 1.07-1.71) for total score and 26% higher (0.99-1.60) for exhaustion, 29% higher for cynicism (1.03-1.62), and 22% higher for diminished professional efficacy (0.96-1.55) in participants who had been under 45 at baseline. After adjustments, only the associations regarding burnout and exhaustion were statistically significant. Burnout was not related to mortality among the older employees.
  
  
  CONCLUSIONS
  Burnout, especially work-related exhaustion, may be a risk for overall survival.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland. kirsi.ahola@ttl.fi
authors.forename: Kirsi
authors.initials: K
authors.lastname: Ahola
authors.forename: Ari
authors.initials: A
authors.lastname: Väänänen
authors.forename: Aki
authors.initials: A
authors.lastname: Koskinen
authors.forename: Anne
authors.initials: A
authors.lastname: Kouvonen
authors.forename: Arie
authors.initials: A
authors.lastname: Shirom
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002055:Burnout, Professional / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D015331:Cohort Studies; D005221:Fatigue / Q000401:mortality / Q000523:psychology; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D016468:Forestry; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D016019:Survival Analysis; D055815:Young Adult