title: Burnout and risk of coronary heart disease: a prospective study of 8838 employees.
abstract: OBJECTIVE
  Burnout is a negative affective state consisting of emotional exhaustion, physical fatigue, and cognitive weariness symptoms. This study was designed to evaluate prospectively the association between burnout and coronary heart disease (CHD) incidence and to test the possibility that this association is nonlinear.
  
  
  METHODS
  Participants were 8838 apparently healthy employed men and women, aged 19 to 67 years, who came for routine health examinations at the Tel Aviv Sourasky Medical Center. They were followed up for 3.4 years on average. Burnout was measured by the Shirom-Melamed Burnout Measure. CHD incidence was defined as a composite of acute myocardial infarction, diagnosed ischemic heart disease, and diagnosed angina pectoris.
  
  
  RESULTS
  During follow-up, we identified 93 new cases of CHD. Baseline levels of burnout were associated with an increased risk of CHD, after adjustment for various risk factors (hazard ratio = 1.41; 95% confidence interval = 1.08-1.85). In addition, we observed a significant threshold effect of burnout on CHD incidence. Participants who scored high on burnout (scores in the upper quintile of the Shirom-Melamed Burnout Measure scores distribution) had a higher risk (hazard ratio = 1.79; 95% confidence interval = 1.05-3.04) of developing CHD on follow-up compared with others.
  
  
  CONCLUSIONS
  Burnout is an independent risk factor for future incidence of CHD. Individuals with high levels of burnout (upper quintile) have a significantly higher risk of developing CHD compared with those with low levels of burnout.
authors.affiliation: Faculty of Management, Tel Aviv University, Israel. tokersha@post.tau.ac.il
authors.forename: Sharon
authors.initials: S
authors.lastname: Toker
authors.forename: Samuel
authors.initials: S
authors.lastname: Melamed
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.forename: David
authors.initials: D
authors.lastname: Zeltser
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D002055:Burnout, Professional / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology*; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology