title: Depression-Burnout Overlap in Physicians.
abstract: BACKGROUND
  Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.
  
  
  METHODS
  In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis.
  
  
  RESULTS
  Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06) for physicians with mild, 10.14 (95% CI 7.58-13.59) for physicians with moderate, 46.84 (95% CI 35.25-62.24) for physicians with severe burnout and 92.78 (95% CI 62.96-136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85) of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.
  
  
  CONCLUSIONS
  This study demonstrates the overlap of burnout and major depression in terms of symptoms and the deficiency of the three-dimensional concept of burnout. In our opinion, it might be preferable to use multidimensional burnout inventories in combination with valid depression scales than to rely exclusively on MBI when clinically assessing burnout.
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Wurm
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Katrin
authors.initials: K
authors.lastname: Vogel
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Holl
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ebner
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bayer
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Mörkl
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Istvan-Szilard
authors.initials: IS
authors.lastname: Szilagyi
authors.affiliation: Arge Burnout, Graz, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Hotter
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kapfhammer
authors.affiliation: Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D002055:Burnout, Professional / Q000150:complications* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003861:Depersonalization / Q000150:complications / Q000453:epidemiology; D003863:Depression / Q000150:complications / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D010820:Physicians / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology