NTERNATIONAL R EVIEW OF I NDUSTRIAL AND O RGANIZATIONAL P SYCHOLOGY 2005 differences (e.g., De Vente, Olff, Van Amsterdam, Kamphuis, &

282 I NTERNATIONAL R EVIEW OF I NDUSTRIAL AND O RGANIZATIONAL P SYCHOLOGY 2005 differences (e.g., De Vente, Olff, Van Amsterdam, Kamphuis, &

Emmelkamp, 2003). The Evidence on the Relationship between Burnout and Physical Health

In this section, we refer to a series of studies by Appels and his colleagues (e.g., Appels & Mulder, 1989) in which the Vital Exhaustion (VE) measure was used. VE was developed to assess a psychosocial precursor of myocardial infarction (Appels, Hoppener, & Mulder, 1987), and represents a construct that to a certain extent overlaps with burnout in that it was defined to include excess fatigue, lack of energy, irritability, andfeelings of d emoralization (Appels & Mulder, 1988). Like other burnout measures, VE was found to

be moderately correlated with depression (van Diest & Appels, 1991), and was foundto be substantially correlatedwith personality factors wid ely recognizedas CVD risk factors, includ ing Type A Behavior Pattern, neuroticism, andhostility (Bennett, Smith, & Gallacher, 1990; Falger & Schouten, 1992). Appels andhis colleagues, in a series of publications referredto below, pioneeredprogrammatic research using the VE to predict objective indicators of physical morbidity. We also refer to research directly assessing the linkages between burnout and physical health in an additional programmatic research effort, startedin the early 1990s (Shirom, 2003b). In these studies, burnout was assessed by the SMBM. The findings provided the first evidence that burnout, as assessed by one of the measures specifically constructedto gauge it, may have a negative influence on physical health. We consider it noteworthy that a study that used both the VE and the SMBM (Lerman et al., 1999), and a study that used all three measures discussed heretofore—that is, the MBI, the SMBM, andthe VE measures (Grossi, Perski, Evengard, Blomkvist, & Orth-Gomer, 2003)—both found the measures to be highly correlated. To illustrate, Lerman and his colleagues (Lerman et al., 1999) reporteda correlation of 0.68 between VE andthe SMBM.

Cardiovascular disease (CVD) The VE was used in several studies to predict the incidence of CVD. In a

4-year prospective study of 3,877 Dutch civil servants, VE was found to be an independent risk factor for acute, nonfatal myocardial infarction with age- adjusted relative risk of 2.3 over 4.2 years of follow-up and after controlling for the effect of classic risk factors (Appels & Mulder, 1988, 1989). This association was also foundin a series of case control studies of men (Falger & Schouten, 1992) andwomen (Appels, Falger, & Schouten, 1993). In another case control study, VE was found to increase the risk of sudden cardiac arrest (Appels, Golombeck, Gorgels, De Vreede, & Van Breukelen, 2002). In studies conducted by Appels and his colleagues, VE was found to

B URNOUT AND H EALTH R EVIEW

be associatedwith sleep disturbances (van Diest, 1990; van Diest & Appels, 1994), andcardiac symptoms (angina pectoris andunstable angina) (Appels & Mulder, 1989). In another study, VE was found to be a precursor of sudden cardiac death (Appels & Otten, 1992).

Hallman and her colleagues (Hallman, Burell, Setterlind, Oden, & Lisspers, 2001) useda burnout measure that consistedof items taken from both the MBI andthe SMBM (andother burnout instruments) to predict coronary heart disease in a case control study that included 538 cases and 10,485 controls, analyzing the data separately for male and female partici- pants. It was for only the women in this study that burnout predicted the Coronary Heart Disease (CHD) cases. In another recent case control study, women with CHD (N ¼ 57) reporteda higher level of burnout compared with matchedcontrols (N ¼ 5,308) when burnout was assessedby the same combinedmeasure (Hallman, Thomsson, Burell, Lisspers, & Setterlind , 2003). The women with CHD also showedlesser coping abilities (Hallman et al., 2003). Using data from the prospective study of healthy men (Appels & Mulder, 1988, 1989), Appels & Schouten (1991) found that a single question measuring burnout, ‘Have you ever felt burnedout?’ was foundto be predictive of myocardial infarction risk [RR (relative risk) ¼ 2.13, p < 0.01]. The findings of these studies lead us to suggest that burnout, and not just VE, may be an independent risk factor for the incidence of CVD.

Diabetes Type 2 Diabetes Mellitus (DM) is a complex disorder characterized by

impairedsecretion of insulin andincreasedresistance to insulin, andis associatedwith increasedrisk of coronary heart disease, peripheral vascular disease, renal failure, and blindness (Bailes, 2002; Beckman, Creager, & Libby, 2002). The past two decades have witnessed an explosive increase in the number of people diagnosed with diabetes worldwide (Seidell, 2000; Zimmet, Alberti, & Shaw, 2001). This epidemic relates particularly to Type

2 DM (Zimmet et al., 2001). It is arguedthat diabetes is becoming one of the main threats to human health in the 21st century (Zimmet et al., 2001). The most important risk factor in the onset of Type 2 diabetes is obesity, in particular abdominal obesity, and there is a worldwide increase in obesity (Visscher & Seidell, 2001). The correlation of increased diabetes with increased obesity has led to the adoption of the term ‘diabesity’ (Zimmet et al., 2001). Other establishedrisk factors for Type 2 DM include age and family history of diabetes. Additional factors found to be associated with this condition are alcohol intake, smoking, reduced physical activity, and diets with a high glycemic load and a low cereal fiber content (Helmrich, Ragland, Leung, & Paffenbarger, 1991; Nakanishi, Nakamura, Matsuo, Suzuki, & Tatara, 2000; Pan et al., 1997; Rimm, Chan, Stampfer, Colditz, & Willett, 1995; Salmeron et al., 1997). Furthermore, certain risk factors for