NTERNATIONAL R EVIEW OF I NDUSTRIAL AND O RGANIZATIONAL P SYCHOLOGY 2005 overload, role conflict androle ambiguity, lack of participation, andlack of

272 I NTERNATIONAL R EVIEW OF I NDUSTRIAL AND O RGANIZATIONAL P SYCHOLOGY 2005 overload, role conflict androle ambiguity, lack of participation, andlack of

social support.

COR Theory and the Construct of Burnout

We start out by presenting our theoretical view of stress andburnout, which is basedon Hobfoll’s COR theory (Hobfoll & Shirom, 1993, 2000). COR was formulated at the individual level of analysis, using social–psychological paradigms, in contrast to other known burnout theories, formulated at the group (e.g., Bakker & Schaufeli, 2000), organizational unit (e.g., Garman, Corrigan, & Morris, 2002), or organizational (Shirom, 2003a, b) levels of analyses. Thereafter, we use this theory to chart out the theoretical links between burnout andmental andphysical health. Accord ing to COR (Hobfoll, 1989, 1998), when individuals experience a loss of resources, they respondby attempting to limit the impact of that loss, through energy conservation, which itself requires additional resource expenditure. When circumstances at work or otherwise threaten the ability of the individual to obtain or maintain requiredresources, stress ensues. COR postulates that stress occurs in one of three conditions: (1) when resources are threatened, (2) when resources are lost, and (3) when individuals invest resources and do not reap the anticipatedrate of return. COR (Hobfoll, 1989, 1998) further postulates that, because individuals strive to protect themselves from resource loss, loss is more salient than gain, andtherefore employees are more sensitive to workplace stresses that threaten their resources. For example, for teachers, having to discipline students and face negative feed- back from their supervisors is more salient than any rewards that they might receive. The stress of interpersonal conflict has been shown to be particularly salient in the burnout phenomenon (Leiter & Maslach, 1988).

A recent meta-analysis (Lee & Ashforth, 1996) examinedhow demandand resource correlates andbehavioral andattitudinal correlates were relatedto each of the three scales that comprise the MBI. In agreement with the COR- basedview of stress andburnout outlinedabove, these authors foundthat both the demand and the resource correlates were more strongly related to emotional exhaustion than to either depersonalization or personal accom- plishment. Also consistent with the COR theory of stress andburnout, these investigators foundthat emotional exhaustion was more strongly re- latedto the demandcorrelates than to the resource correlates. These meta- analytic results were subsequently reconfirmed by additional studies, like the study by Demerouti and her associates (Demerouti, Bakker, Nachreiner, & Schaufeli, 2000) who useda burnout scale that focusedon energy depletion.

Applying these notions to the relationships of burnout with mental health, we argue that people feel burned-out when they perceive a continuous net loss, which cannot be replenished, of the physical, emotional, or cognitive energy that they possess. The net loss, in turn, cannot be compensatedfor by

273 expanding other resources, or borrowing, or gaining additional resources

B URNOUT AND H EALTH R EVIEW

by investing extant ones. Burned-out individuals may exacerbate their losses by entering an escalating spiral of losses (Hobfoll & Shirom, 2000). Then, they may start manifesting symptoms of psychological withdrawal, like acting with cynicism towardanddehumanizing those with whom they interact, possibly even reaching an advanced stage of burnout, where the predominant symptoms are those of depression. As noted by Schaufeli and Enzmann (1998), longitudinal studies to date have not supported the notion that there is a time lag between the stress experience andthe feelings of burnout. It couldbe that stress andburnout change simultaneously, hence the failure of the eight longitudinal studies examined by Schaufeli and Enzmann (1998) to reproduce the effects of stress on burnout found in most cross-sectional studies.

COR may be applied to advance our understanding of the linkages between burnout and indicators of mental health, like anxiety and depression. COR implies that the early stages of burnout are characterizedby a process of depletion of energetic resources available for coping with work-related stresses and other threatening demands (Hobfoll & Shirom, 2000). During these early stages, individuals still try to engage in active coping to prevent further losses of energetic resources andpossibly replenish lost resources. Burnout may occur concomitantly with a high level of anxiety, due to the active coping behaviors that usually entail a high level of arousal. When and if these coping behaviors prove ineffective, the individual may give up, and engage in emotional detachment and defensive behaviors that may lead to depressive symptoms (cf. Shirom & Ezrachi, 2003). Cherniss (1980a, b) found that in the later stages of burnout individuals behave defensively and, hence, display cynicism toward clients, withdrawal, and emotional detachment (for empirical support see Burke & Greenglass, 1989). These attempts at coping have limitedeffectiveness andoften serve to heighten burnout and problems for both the individuals and the organizations in which they work.

On the Chronicity of Burnout

The last points give rise to an issue which is very relevant to the impact of burnout on health: the extent to which burnout is a chronic phenomenon, i.e., persisting at a constant level over extended time periods. If indeed burnout represents continuous loss of resources that cannot be easily re- plenished, as argued above, it should be quite stable when measured diachronically. To assess the cross-time stability of burnout, we have limitedour review to complete panel studies that have usedthe emotional exhaustion subscale of the MBI: six such longitudinal studies, all using only a two-wave panel design, were identified. The findings that concern the cross- time correlation foundfor the emotional exhaustion subscale of the MBI

274 I NTERNATIONAL R EVIEW OF I NDUSTRIAL AND O RGANIZATIONAL P SYCHOLOGY 2005 are summarizedbelow. Bakker, Schaufeli, Sixma, Bosveld , andVan

Dierendonck (2000), who studied 207 general practitioners with a 5-year time interval, founda d iachronic correlation of 0.50. Lee & Ashforth (1993), who studied 169 managers of a public welfare agency with a time lag of 8 months, reporteda diachronic correlation of 0.52. Leiter (1990), who investigated122 mental health employees over a 6-month period, founda correlation of 0.49 between waves. Leiter andDurup (1994) reportedfinding

a diachronic correlation of 0.70 in a study of 151 hospital professionals assessed 6 months apart. Yet another longitudinal study (Toppinen- Tanner, Kalimo, & Mutanen, 2002) followed556 employees over a period of 8 years andfounda correlation of 0.49. Finally, Van Dierend onck, Schaufeli, and Buunk (2001), in secondary analyses of data coming from

5 different samples of 933 employees, with time intervals varying between

3 months and1 year, reporteda correlation of 0.60. We therefore conclude that, regardless of the sample make-up, the cultural context, and the length of time of the follow-up survey, the phenomenon of burnout exhibits remark- able stability, attesting to its chronic nature. The relatively high cross-time correlations found for burnout in longitudinal studies could be related to the theoretical possibility discussed above, namely that stress and burnout are reciprocally relatedover time.

Burnout and Depression

Depressive symptomatology, as distinct from the clinical state of depression, includes feelings of sadness, emptiness, hopelessness, helplessness, dysphoric feelings, andlow energy. It is the latter component of depressive symptoma- tology that gave rise to the conjecture that burnout may overlap with depression (Schaufeli & Buunk, 2003). Theoretically, the two constructs are different from each other. Depression signifies a generalized distress encompassing all life domains, whereas burnout is context-specific in that it refers to the depletion of individuals’ energetic resources at work (as assessedby the SMBM) or to a set of work-relatedattitudes (as assessed by the MBI).

We posit that the unique core of burnout, depletion of energetic resources, is distinct in its content and nomological network from both depression and anxiety, as demonstratedby Corrigan et al. (1994) andby Leiter andDurup (1994). Measures of depression, such as the Beck Depression Inventory (BDI: Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) include items whose contents gauge passivity andrelative incapacity for purposeful action. In addition, as proposed above, later phases of burnout may be accompanied by depressive symptomatology. These arguments provide a plausible theoretical explanation of the often reportedhigh positive correlation between burnout andmeasures of d epression (e.g., Meier, 1984; Schaufeli & Enzmann, 1998). Basedon these theoretical arguments,

275 we expect burnout to be conceptually distinct from depression. Depressive

B URNOUT AND H EALTH R EVIEW

symptomatology is affectively complex, andincludes a lack of pleasurable experience, accompaniedby feelings of anger, guilt, apprehension, and physiological symptoms of distress. Moreover, cognitive views of depression regardit as relatedprimarily to pessimism about the self, capabilities, andthe future (Fisher, 1984).

There are nevertheless two theoretical considerations supporting the expectation that burnout anddepression shouldshare a significant amount of their respective variance. First, these two conceptual entities share some antecedent variables: chronic stress influences both burnout and depression. Second, depressive symptomatology, gauged as a trait, is regarded as being a component of one of the Big Five personality factors—neuroticism (McCrae & John, 1992)—which has been shown to be closely relatedto burnout (Zellars, Perrewe, & Hochwarter, 2000). Third, Leiter and Durup (1994) arguedthat emotional exhaustion, one of the three components of the MBI, overlaps the loweredenergy andchronic fatigue symptoms, regarded as symptoms of depression (dysthymic disorder). Leiter and Durup (1994) further arguedthat the depersonalization component of the MBI implies social withd rawal andlearnedhelplessness, theoretically regard edas key elements of depressive states.

This theoretical position may be exemplifiedby burnout among members of the helping professions, such as teachers, social workers, andnurses. When facedwith overloadandinterpersonal stress on the job on an ongoing basis, the key issue for them is the amount of emotional energy they needto meet these job demands. When they feel emotionally exhausted, direct or problem-focusedcoping, which invariably requires that they invest emotional energy, is no longer a viable option. Presumably, they employ emotion-focusedcoping in an effort to ameliorate their feelings of emotional exhaustion, andattempt to distance themselves from their service recipients, psychologically withdraw from their job tasks, or limit their exposure to their clients. This may explain the often foundlinkage between emotional exhaustion andcynicism (Lee & Ashforth, 1996).

Evidence in Respect of the Relationship between Burnout and Mental Health