Occupational burnout and chronic work disability: An eight-year cohort study on pensioning among Finnish forest industry workers

Abstract

Background

The objective was to explore if burnout, a syndrome from chronic work stress, predicts work disability during eight years among industrial employees. We investigated whether burnout would predict disability in initially healthy employees and all subgroups by the most common causes for disability.

Methods

Of the participants in a company-wide survey (n = 9705, 63%) performed in 1996, 8371 employees were identified and 7810 provided full information. The impact of burnout and its sub-dimensions, assessed with the Maslach Burnout Inventory-General Survey, on being granted register-based new disability pension till 2004 was analysed with Cox hazard regression and multinomial regression. The analyses were adjusted for socio-demographic factors, registered medication use, and self-reported chronic illness at baseline.

Results

The hazard ratio (HR) for new disability pension was 3.8 (95% confidence interval CI 2.7–5.4) with severe burnout. The risk of severe burnout and severe exhaustion for work disability attenuated but remained significant after adjustments. The association between severe burnout and work disability was significant also in the subpopulation of employees without registered medication at baseline but not among employees healthy by self-report. Crude associations between burnout and all categories of cause-specific disability were significant. The exhaustion dimension predicted work disability due to mental and miscellaneous disorders after adjustments.

Limitations

A non-random one-branch sample was used. The final sample covered 50% of eligible employees.

Conclusions

In industrial work, burnout-related chronic work disability is general in nature. Burnout predicts work disability among healthy employees when health is assessed with registered use of medication but not when it is determined by self-report.

Introduction

Occupational burnout refers to a persistent negative state of mind resulting from prolonged work stress (Schaufeli and Enzmann, 1998, Maslach et al., 2001). It is primarily characterized by exhaustion that develops during long-term involvement in an adverse work situation (Shirom, 1989, Kristensen et al., 2005). Predisposing work characteristics include high workload, role conflict and ambiguity, low predictability, lack of participation and social support, and experienced unfairness (Schaufeli and Bakker, 2004, Borritz et al., 2005, Maslach and Leiter, 2008). Exhaustion may lead to changes in attitudes towards work (cynicism) and oneself as a worker (diminished professional efficacy) (Taris et al., 2005). According to the multidimensional definition of burnout, these three dimensions constitute the syndrome irrespective of profession (Schaufeli et al., 1996).

Burnout has been shown to associate with mental disorders and physical illness (Ahola et al., 2005, Honkonen et al., 2006) as well as with sickness absence (Borritz et al., 2006, Ahola et al., 2008). Two explanations exist regarding these associations. As a consequence of chronic stress, burnout may be a phase in health deterioration (McEwen, 1998, Shirom et al., 2005). In longitudinal settings, burnout has been reported to lead to myocardial infarction (Appels and Schouten, 1991), depressive symptoms (Greenglass and Burke, 1990, Ahola and Hakanen, 2007), and increased rate of sickness absence among workers (Toppinen-Tanner et al., 2005, Borritz et al., 2006). Burnout has also been found to associate with anxiety (Lindblom et al., 2006, Ahola, 2007) and musculoskeletal pain (Soares and Jablonska, 2004, Miranda et al., 2005).

However, it is also conceivable that employees who have health problems may face difficulties in meeting their job demands, drift into jobs with low resources, and experience their work situation more negatively (De Lange et al., 2005). Chronic health problems may therefore cause experiences of burnout. Accordingly, workers with higher prevalence of depressive symptoms (McCranie and Brandsma, 1988, Ahola and Hakanen, 2007), cardiovascular disease (Hallman et al., 2003), and various chronic illnesses (Donders et al., 2007) have reported higher levels of exhaustion or burnout. So far, there is uncertainty concerning the causal connections between burnout and health due to limited prospective evidence on burnout-related health loss.

The number of people receiving disability benefits has been continuously increasing (Stattin, 2005). In Finland, mental disorders, together with musculoskeletal disorders and cardiovascular diseases, are the most common causes for disability (Finnish Centre for Pensions and Social Insurance Institution of Finland, 2007). Although many individual factors affect work disability (Gravseth et al., 2007), evidence is accumulating regarding the importance of poor psychosocial quality of work (Laine et al., 2008). Just recently, in a population-based Finnish study, burnout was for the first time shown to independently predict disability pension during a four-year follow-up (Ahola et al., in press). However, due to the relatively short follow-up period, a low number of cases did not allow for stratified analyses. For instance, it was unclear whether burnout contributed to work disability also among the initially healthy employees. In addition, little is known on whether burnout is related to specific causes of disability, for example mental disorders, or whether it relates to equally to all causes for disability.

The main objective of the present study was to examine whether there is a relationship between the level of burnout and subsequent new disability pension during a follow-up period of over eight years in industrial work. Secondly, to explore the effect of initial health status on the association between burnout and work disability, the analyses were additionally stratified both by the register-based use of medication and self-reported chronic illness at baseline. Thirdly, in order to examine the specificity of the burnout-related health risk, yet another aim was to analyse the burnout–disability relationship according to the diagnosis for which the disability was granted, grouped by the most common causes of work disability in Finland.