Why does Burnout Matter at this Stage of the Pandemic?
If you are reading this blog and you are not feeling tired then you may be one of the lucky ones. Many people in a range of professions have fallen fowl to burnout over the course of the pandemic.
This blog is part of a 3-part InSPIre the Mind series. This introductory blog explores the science of burnout and what research tell us about burnout amongst people working “on the frontlines” during the pandemic, such as medical staff and teachers. Part 2 explores how working from home can affect our mental health. Part 3 will share some of the emerging evidence for preventing and recovering from burnout.
Burnout is a pandemic buzzword, but what is it?
Burnout refers to feeling an increased sense of cynicism, tiredness and reduced sense of competence at one’s job according to burnout researcher Maslach and colleagues (1996). In 2019, the World Health Organization officially recognized burnout in its International Classification of Diseases (a global standard in disease identification) but clearly stated that the term “should not be applied to describe experiences in other [nonoccupational] areas of life.”
So, if burnout is a phenomenon strictly in the work domain, who may be at risk of burnout at this point in the ‘pingdemic’? In this blog, we will look at some of the emerging research conducted over the course of the pandemic 2020–2021 and consider how and why does it affect our bodies and minds?
I’m a research associate at the Evidence Based Practice Unit, a partnership between UCL and the Anna Freud Centre. As a psychologist, I’m passionate about research that seeks to understand the factors that promote human wellbeing or reduce the risk of developing mental ill health both in-person and online.
At this stage in the pandemic, I cannot deny, like many people, I’m a little tired.
The shifting demands of the pandemic has been difficult for many. There have been new stressors to accommodate and sources of existential uncertainty, new ways of living and new ways of working to adjust to. From furlough to self-isolation, many have felt increased stress at multiple levels. The pandemic has had a profoundly affected both physical and mental health with reported rates of depression and anxiety increased globally, as well as the rise of burnout.
Burnout was Identified in New York
Psychologist Herbert Freudenberger coined the term when he noticed that volunteers at a New York mental health clinic who had previously begun their involvement at the clinic with optimism and zeal, had become increasingly exhausted and began to show “quickness to anger” and closed thinking. Freudenberger wrote about burnout in his book that became an authority on the subject.
“Joyful activities, like playing with my infant daughter, suddenly felt like an obligation and a chore…. I felt incapable, overwhelmed, and trapped — and when people pointed out that something was wrong, it only dug the hole even deeper.” — Kieran Ti
Recent research suggests that there may be 4 phases of burnout. Each phase is linked with a measurable change in cortisol levels (a stress hormone) in the body. More cortisol increases glucose levels in the bloodstream, ramps up the brains use of glucose and makes available substance that repair body tissue. Cortisol, in concert with another important hormone, Adrenaline, renders us in a state of flight or flight, directing the blood flow away from digestion, reproduction and growth activity. Cortisol reminds the brain that something is wrong, influencing mood, motivation and levels of fear. Cortisol is essential, if levels are too low then a person can experience an adrenal crisis (for example in a medical condition called Addison’s disease where the adrenal glands are damaged).
Too much cortisol release over time (with the HPA continually activated) however, can be damaging to both the body and the brain.
The levels of cortisol in the body are finely tuned by the HPA axis, the pathways that connect the brain and the adrenal glands, the small triangles that sit on the top of the kidneys.
Four Phases of Burnout
1) Engagement — in this stage there is some cortisol but this is a normal level that is associated with energetic engagement and hard work, similarly to feelings of stress linked to coping with a difficult exam or deadline. The HPA axis is functioning.
2) Strain- in this phase the employee is still engaged and dedicated to the job, but tiredness is common and levels of cortisol are high.
3) Cynicism- this is where dedication drops off and cortisol levels peak. It is increasingly difficult to cope. Sustained high levels of cortisol are linked with mental ill health. HPA activity reduces.
4) Burnout- in this phase exhaustion sets in, cynicism reduces, the HPA activity further reduces, an individual may overreact to smaller moderate stressors.
So, what does it mean to be not burned out?
Burnout experts Maslach and Leiter suggest that the opposite of burnout has been thought about as feeling energised at work — such as having vigour and get up and go, and a sense of commitment to the role and organisation.
Google ran some research to understand what characteristics make a team successful at work in their research project Project Aristotle, an in-house research initiative that sought to understand through interviews with 180 different teams made up of between 3–50 employees. The project found that a key ingredient was “psychological safety” which they defined as “Team members always need a safe space to work, question, take risks and even make mistakes, without the fear of judgment, feeling incompetent or the greater ramifications”. Other ingredients included dependability, structure and clarity, meaning and impact.
Healthcare Workers and Burnout: Reaching Breaking Point?
Whilst burnout can occur in any profession, there has been a marked rise of burnout within healthcare workers during the Covid-19 pandemic. Healthcare workers operating on the “front line” in providing care to Covid-19 patients have been found to have high rates of burnout, and especially among staff in intensive care and nurses.
A British Medical Association questionnaire with 6126 health care staff in April 2020 found that more than 40% of doctors were experiencing depression, anxiety, stress, or burnout that had been ramped up by the pandemic. 60% reported more fatigue or exhaustion than pre-pandemic.
Research found that factors contributing to stress in healthcare workers in the UK included:
· Worries about their own health
· Worries about their family’s health
· Worries about access to personal protective equipment (PPE) (e.g. masks and gloves and other protective clothing/equipment)
· Worries about being able to do their job effectively
· Managing the higher number of patient deaths at work
If a healthcare worker was female and redeployed, this same research found that they were more likely at risk of burnout. Research for all professions finds that burnout is not gender-neutral and because of additional household and possible childcare duties, women are often at greater risk.
Barriers to Getting Help
The problem is further compounded by the fact that many people suffering will not get, receive or have access to suitable support.
In the chart below by Ferry et al, 2021, it shows that as many as 77% of health workers felt stressed but did not access support. Reasons that healthcare workers didn’t get it included:
· Feeling support wasn’t needed
· Not having time
· The support offered didn’t feel relevant to the person
· Not wanting colleagues to know they were suffering from stress
Teachers and educational staff and burnout
Teachers already had a demanding job before the pandemic. However, the return to teaching required management of both in-person teaching, and online teaching, keeping in step with changing government guidance and managing children that had been emotionally and educationally impacted by the pandemic, placed an additional burden on teaching staff. Further still, teachers were further at risk of getting Covid-19.
In the UK and in many other countries, teachers had to provide both in person and online teaching during the pandemic.
Research conducted on the topic of levels of burnout among Spanish teachers in five regions in Spain found that burnout was high in teachers, and that female teachers were more negatively affected, again, as per other research, showing a gendered dimension. Of the sample of teachers included in the study, 60.2% had high levels of emotional exhaustion and 69.3% of teachers surveyed reported low professional efficacy.
Interestingly, teachers with higher levels of emotional intelligence had lower levels of burnout, suggesting that socio-emotional skills may help protect teachers from burnout. Older teachers had lower levels of burnout also that could mean experience played a protective role.
It is perhaps important to note that a lack of professional efficacy in the context of the pandemic doesn’t mean suddenly not being able to do one’s job, it’s about the capacity to do an existing job in a completely new set of circumstances.
What about people working from home via Zoom — does that contribute to burnout? What can we do about it?
In Part Two of this InSPIre the Mind blog, we will explore how working from home and “Zoom fatigue” can affect our mental health and risk of burnout.
In Part Three, I will look at the evidence for beating burnout and achieving greater wellbeing. There is a lot of advice on the internet, but what is the evidence of effectiveness to reduce burnout and stay well?
Thanks for reading.