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Can burnout measure be useful in screening for disability pensions?
  1. Joanna W Wieclaw
  1. Joanna W Wieclaw, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark; joanwiec{at}rm.dk

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There is a worrying tendency of a growing proportion of work disabilities to result from mental health problems.1 This calls for more research into the causes of this development and in prevention strategies.

Generally, the reasons for receiving a disability pension can be seen as a combination of life circumstances and individual characteristics, including inborn/genetic susceptibility to illness (both physical and mental) and personality characteristics. Work life factors play a central role for persons of an active working age. Holding a job not only provides a source of income, socioeconomic position and status, but is also a vital part of a person’s identity and meaning in life. Therefore, becoming a disability pensioner not only has economic consequences, which are partly taken care of by the disability pension, but also affects personal life, the feeling of meaningfulness and one’s position in society. For society as a whole, disability pensions impose manpower shortages and economic burdens. Therefore, preventing disability pensions is crucial and here work environment factors, which are amenable to change through, for example, early intervention and attempts to increase job satisfaction, are important areas of research.

The paper “Occupational burnout as a predictor of a disability pension: a population-based cohort study” (see page 284)2 addresses an important and current issue in a methodologically sound way.

The relation between work factors, health effects and a subsequent disability pension is documented to some extent, but there are still several unanswered questions, especially regarding work and mental health. A recent meta-analysis provides consistent evidence of an association between several psychosocial work stressors and common mental disorders. However, another review of epidemiological evidence of the risk of depression, raises doubts about the robustness of these associations and points to several methodological problems in the studies.3 4 A particular criticism concerns the lack of independent measures of stressors and outcomes and no account of subclinical symptoms at the baseline.4

The article by Ahola et al2 meets some of the above criticism by using a medical examination and a standardised, clinical assessment of mental health problems to account for symptoms of ill health at baseline and controlling for their effects in subsequent data analyses. The outcome was assessed by documented register records of disability pensions and their causes. The association found was strong as, after adjustment for socio-demographic factors and health at the baseline, one point increase in burnout was related to a 49% rise in the odds of receiving a disability pension.

However, a central problem of the study concerns the predictive variable of burnout and its measurement, which is controversial. Burnout is not clinically recognised (is not included in International Classification of Diseases (ICD) or Diagnostic and Statistical Manual classification) and its conceptualisation is still under discussion, particularly regarding questions of it being a process, a state or a syndrome, the nature and weighting of its components and most importantly differential diagnostics. The self-reported assessment method and the use of Maslach Burnout Inventory versus Maslach Burnout Inventory–General Survey is also an issue.5 6

As the authors themselves point out, the association between mental disorders and disability pensions is well documented and, if burnout is viewed as a kind of mental disorder or its subclinical stage, it is not surprising that it predicts a disability pension.

However, the question of the role burnout plays in the possible causal pathway between work stressors, health problems and disability pensions remains unsolved. Burnout can be regarded as an independent predictor of a disability pension but burnout itself may result from not being able to meet job demands because of suffering from, not necessarily diagnosed, health problems that lead to a disability pension.

The study shows that a small proportion of persons with severe burnout (2%) accounted for 22% of a new disability pension during the follow-up. This finding emphasises the need to study the process of burnout rather than its endpoint, when it is probably too late to provide an effective intervention and/or treatment to diminish the risk of a disability pension.

As in most research, individual factors taken into account in the present study cover general socioeconomic variables. However, there is evidence that certain personality traits (neuroticism, low self-esteem) and types (dependent, perfectionist) are associated with the risk of anxiety and depressive disorders.79 It is likely, that the same personality characteristics are related to both the risks of burnout and disability pension. Equally, life events, both private and work related, have been consistently shown to be predictors of mental health disorders.4 10 11 It can be expected that they also constitute a risk factor for work disability pensions.

In the study, burnout was related to occupational grade, but the categories used were very broad. Studies show that there is a substantial variation in the level of burnout and mental health disorders across occupations.6 12 It would be interesting to see if the associations are particularly strong in specific occupational groups.

The study by Ahola et al2 has demonstrated that the burnout measure, despite some concerns about its validity, is a predictor of disability pension. However, an important area of future research will be to investigate if it can be used as an effective screening tool for persons at increased risk of health problems and disability pension. Another challenging issue, from an occupational health and preventive perspective, is providing convincing evidence of the relationship between burnout and specific occupational exposures.

However, if we want to develop a comprehensive understanding of the complex mechanisms leading to disability pensions, we need to use multidimensional study designs that focus on work stressors, but at the same time take into account assessment of personality characteristics and life events. This can in turn provide a better basis for effective preventive measures that are targeted both at improving working conditions and providing guidance regarding job choices, task performance, and coping with work stressors. The study by Ahola et al2 is an important step in that direction.

REFERENCES

Footnotes

  • Competing interests: None declared.

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