Anxiety & Mood
Burnout: what it is, the signs and what helps
What burnout is according to the World Health Organization, its three signs, how it differs from depression and what research shows about what helps.
Burnout is a syndrome that results from chronic stress at work that has not been successfully managed. The World Health Organization describes it with three features: exhaustion, distance or cynicism towards work, and reduced effectiveness. It is not a medical diagnosis but an “occupational phenomenon”. It is, however, fairly closely linked with depression and anxiety, so it is worth an assessment when it persists.
What the World Health Organization says
In the International Classification of Diseases (ICD-11), the WHO describes burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed, with three dimensions [1]:
feelings of exhaustion or energy depletion,
increased mental distance from your job, or feelings of negativism or cynicism about it,
reduced professional efficacy.
Two details of the definition matter. First, burnout is classed as an “occupational phenomenon” and not as a medical condition. Second, it refers only to work: the WHO notes that the term should not be used for experiences in other areas of life [1].
How it shows in daily life
Exhaustion: tiredness that does not go away even after rest.
Distance and cynicism: indifference, irony or anger about work, colleagues or clients, with a “just getting through the day” attitude.
Reduced effectiveness: a feeling that whatever you do is not enough or has no effect, and difficulty concentrating.
Burnout is not a personal weakness. Not being well in an unhealthy environment is not a failure; it is an expected reaction. This does not mean you cannot do anything. It means the solution is not only “to become stronger”.
Why it happens
Burnout is not caused by workload alone. The researchers Christina Maslach and Michael Leiter link it with a mismatch between the person and six areas of working life [2]. Two findings show what we mean:
In a study of 466 employees measured twice, one year apart, those who were in an unstable state and felt unfairness at work went on to burnout the following year [3].
In 667 nurses, the most critical areas were value conflicts and insufficient rewards. Cynicism was the dimension of burnout most strongly linked with the intention to leave the job [4].
Burnout or depression?
The two look alike: tiredness, less interest, difficulty concentrating. A meta-analysis by researchers at the University of Macedonia in Thessaloniki found that burnout is significantly related to depression and anxiety, but is not the same as them: they are different conditions that often occur together [5].
What it is: burnout, an occupational phenomenon, not a diagnosis; depression, a medical diagnosis.
What it affects: burnout, only work; depression, not limited to work.
Criteria: burnout, the three WHO dimensions; depression, at least 5 symptoms, most of the day, nearly every day, for at least 2 weeks [8][9].
In plain words: if low mood, loss of interest or hopelessness follow you outside work too, you need an assessment for depression. Depression has its own treatment. More in the article on depression symptoms in adults.
How common is it? Why the numbers vary so much
You will read very different figures. The reason shows in a systematic review on doctors: 182 studies with 109,628 doctors from 45 countries used at least 142 different definitions of burnout, and the rates ranged from 0% to 80.5% [6]. In other words, there is not yet a commonly accepted way to measure it. Be cautious with headlines such as “half of all employees have burnout”.
What helps
Changes in both the person and the environment. In a review of 25 prevention programmes, 80% reduced burnout. Those aimed only at the individual helped for six months or less. Those that also included changes in the organisation had benefits that lasted 12 months or more. In all of them, the benefit faded over time [7].
Rest that is real rest. Boundaries between work and rest, sleep, routine and physical exercise as an outlet.
Checking for what may lie behind it. Depression, anxiety, insomnia or adult ADHD are treated differently, and an assessment tells them apart.
A review in the journal World Psychiatry notes that studies evaluating treatments for burnout are still few. The aim of treatment is usually for the person to be able to return to work and cope [2].
When work becomes the main source of worth, it can cover a feeling of inadequacy: “if I don’t work hard, what am I worth?”. A practical first step is a limit on working hours, with an activity diary. In people who get by through over-effort, I also check for ADHD, because intelligence and hard work can compensate for it for years. See also the article on ADHD at work.
Demands do not create obligations. A “no” can be said briefly and in writing, without long justifications. And before a big decision, such as resigning, it helps to first explore what can be improved where you are: the pressure eases and you regain a sense of control.
When to ask for help
The exhaustion has lasted for weeks and does not improve with rest or time off.
Low mood, loss of interest or hopelessness follow you outside work too.
You sleep badly, drink more or need something to “get through” the day.
The situation consistently gets in the way of your work, relationships or health.
You are considering big decisions, such as resigning or changing career, while exhausted.
Safety: If you have thoughts that life is not worth living or thoughts of harming yourself, ask for help immediately: 166 (ambulance, EKAV), 112, or the Suicide Prevention Line 1018.
How I can help
Book a psychiatric assessment, at the practice in Trikala or online. The page on stress and burnout describes how we work at the practice. If your schedule leaves no room for travel, the assessment can also take place by video call: see how working with an online psychiatrist works, or book an appointment.
This article is educational and does not replace individual clinical assessment. Do not change or stop any treatment you are already taking without talking to your doctor.
Sources
World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. 28 May 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016. https://doi.org/10.1002/wps.20311
Maslach C, Leiter MP. Early predictors of job burnout and engagement. J Appl Psychol. 2008. https://doi.org/10.1037/0021-9010.93.3.498
Leiter MP, Maslach C. Nurse turnover: the mediating role of burnout. J Nurs Manag. 2009. https://doi.org/10.1111/j.1365-2834.2009.01004.x
Koutsimani P, Montgomery A, Georganta K. The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol. 2019. https://doi.org/10.3389/fpsyg.2019.00284
Rotenstein LS, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018. https://doi.org/10.1001/jama.2018.12777
Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010. https://doi.org/10.1016/j.pec.2009.04.008
National Institute of Mental Health. Depression. Revised 2024. https://www.nimh.nih.gov/health/publications/depression
Chand SP, Arif H. Depression. StatPearls, NCBI Bookshelf. Last updated 17 July 2023. https://www.ncbi.nlm.nih.gov/books/NBK430847/
