Developments in burnout research and associated fields of study

In the literature, different stages in burnout research can be observed. Table 2-1 below summarises the different stages in burnout research and identifies key researchers. The different stages in burnout research are discussed in greater detail below the table.

Table 2-1: Overview of key researchers and their role in the emergence and development of burnout as an academic field of study

Period Key authors Remarks

Late 1960 and early 1970

Bradley (1969), Freudenberger (1974)

First use of the term burnout and first definitions of burnout Late 1970s and

early 1980s

Maslach (1978, 1982) Maslach and Jackson (1981), Pines and Maslach (1978)

Burnout as a three component syndrome, development of Maslach Burnout Inventory (MBI) Mid 1980s and

1990s

Many researchers including Armstrong, Buunk, Chernis, Cordes, Cooper, Van Dierendonck, Dougherty, Enzmann, Golembiewski,

Graham, Groenewegen, Jackson, Kirwan, Leiter, Marek, Maslach, Munzenrider, Pines, Ramirez, Schaufeli, Sixma

Increased acceptance of MBI as golden standard for measuring burnout, over 6,000 papers published. A third of studies carried out in healthcare sector (other large sectors include education, management and police and correction). Burnout found to be common in the human services, especially healthcare.

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2000s As 1980s and 1990s Continuation of 1990s research Late 2000s,

2010s

Maslach, Leiter, Schaufeli, Bakker, Demerouti (shift towards engagement)

Caplan, Linzer, Taylor, Vedsted predominantly publish in medical journals.

Shift of focus towards

engagement by leading authors. Studies with a focus on burnout remain to be published in profession specific journals.

In their research, Cooper et al. (2001) provide an overview of the emergence of the concept of burnout in the social sciences research. In the late 1970s and the early 1980s, burnout research focussed on the concept of burnout itself. In these years several definitions of burnout were proposed (cf. also Section 2.2.3, p. 20) and the academic discourse focussed on what was, and what was not, part of the burnout syndrome. At that time, burnout research was done exclusively in the context of the human services. In the first half of the 1980s a great number of empirical studies were carried out, still all within the context of the human services. The work of Maslach and her colleagues (e.g. Maslach 1982, Maslach and Jackson 1981) was key in the acceptance of the three-component conceptualisation of burnout, as described by

O’Driscoll and Cooper (1996).

The concept of burnout was not accepted easily by the scientific

establishment. Schaufeli et al. (2009) describe how the fact that the term burnout actually arose from practice, and not from science, contributed to the initial rejection of the concept of burnout as “pop psychology” for over half a decade. In the mid-1980s burnout became increasingly en vogue as a

concept and a psychological syndrome. Schaufeli et al. (2009) estimate, that in the 1980s and 1990s over 6,000 scientific articles were published on the topic.

Like it took many years for burnout to become an established concept by the field of science, it took many years for the syndrome to become accepted by the medical field. Bianchi et al. (2015) note that it took until the 10th _{edition of}

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the International Classification of Diseases (ICD), published in 1992, two decades after the initial scientific publications on burnout, for burnout to gain recognition as a formal disease.

Although the vast majority of burnout studies focus on human services, with a particular emphasis on medical practice, burnout prevalence in other

industries has increasingly been examined over the years (Schaufeli and Enzmann 1998). Schaufeli and Enzmann (1998) have estimated that one in three burnout studies were carried out in the healthcare sector and one in four in teaching and education. They identify social work, administration and management as well as police and prisons as other relatively large sectors.

While in the 1980’s and the 1990’s the vast majority of studies were

published in journals in the fields of psychology and organisational behaviour, the 21st _{century studies on burnout are predominantly published in profession}

specific journals. Examples of recent studies on physician burnout that are published in medical journals are Taylor et al. (2005), Linzer et al. (2009), Caplan (2013) and Vedsted et al. (2013), who published in the Lancet, the Annals of Internal Medicine, the British Medical Journal, and the International Journal of Family Medicine respectively.

For other professions, one can observe a similar change in the dissemination route. Studies on teacher burnout nowadays seem to be predominantly published in field specific journals such as Teaching and Teacher Education (e.g. Fernet et al. 2012, Van Droogenbroek et al. 2014), and the Journal of Educational Psychology (e.g. Collie et al. 2012). In all these publications, neither the concept of burnout or its associated measurement instrument, the MBI, are the object of study, Most studies published in the last two decades, use the MBI without further investigation of the measurement instrument itself, but focus on factors that are associated with increased burnout scores instead.

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The other stream can be seen as the further development of the field of burnout science, which consists of studies of a more fundamental nature. The focus of research, however, has shifted towards employee engagement, as illustrated in Figure 2-1 below.

Figure 2-1: Stages in burnout research

Yousef-Morgan and Bockorny (2014, p. 36) note that ‘positive psychology’ significantly influenced burnout research. In the second half of the 20th

century, psychology was based on a disease model, fixing weaknesses, and business psychology and HR-studies followed suit. Studies on negative job aspects such as poor performance, stress and burnout, work-life conflict, counterproductive work behaviours prevailed over studies that examined good or successful behaviour. Human strengths were ignored and studies on human strengths were underfunded (Seligman and Csikszentmihalyi 2000). This has led Luthans (2002a, 2002b) and others to plea for a shift towards positive psychology.

Near the end of the 20th _{century, briefly before the ‘formal’ plea for a shift}

towards positive psychology, Maslach et al. (1997) hypothesised that burnout and work engagement were two opposite poles in the same continuum. In the past fifteen years, employee engagement has gained increasing momentum. Several researchers that can be identified as the founders of burnout research, were now researching burnout in conjunction with

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engagement or engagement instead of burnout (Bakker et al. 2008, Maslach and Leiter 2008, Schaufeli and Bakker 2010, Schaufeli 2014). In fact,

Schaufeli had transformed the Utrecht Burnout Scale to become the Utrecht Work Engagement Scale. This scale does not measure emotional

exhaustion, depersonalisation and reduced accomplishment, but vigour, dedication and absorption instead (Schaufeli et al. 2002). To measure vigour, dedication and absorption, the same or similar questions as used in the MBI are used, now phrased in a positive manner, e.g. “At my work I feel bursting with energy” instead of “I feel emotionally drained from my work”. There is, however, no consensus amongst researchers, how burnout and engagement relate to one another. Maslach et al. (1997) have adopted the so-called burnout antithesis approach, defining burnout and engagement as the positive and negative endpoints of a single continuum, while Schaufeli et al. (2002) define engagement as a distinct concept in its own right, albeit that it is negatively related to burnout. Schaufeli et al. (2002) define work

engagement as “a positive, fulfilling, work related state of mind that is

characterized by vigour, dedication, and absorption” (Schaufeli 2014, p. 18). Some researchers argue that engagement is old wine in new bottles, a rebranding of the burnout construct (e.g. Jeung 2011).

While the focus of the ‘big names in burnout research’ (e.g. Maslach, Schaufeli, Bakker and Demerouti) seems to shift from burnout to

engagement, the ‘traditional’ physician burnout studies keep being carried out, nowadays published predominantly in medical journals

For this study, a choice had to be made between following the latest developments in burnout research, measuring engagement instead of burnout, or using the well-established concept of burnout instead of the relatively new concept of engagement. Considering:

a) that one of the aims of this study is to provide a repeat measure of burnout prevalence amongst Dutch GPs, (cf. Section 1.3, p. 7),

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b) that there is a well-established relationship between high burnout scores and adverse effects (cf. Section 2.4.5, p. 47) and

c) that burnout remains to be a relevant concept as evidenced by numerous publications in the last decade,

the choice was made to not follow the leading researchers by using the concept of resilience, but to use the well-established concept of burnout instead.