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Brief history of burnout

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• Peer review
• Rajvinder Samra , lecturer
• School of Health, Wellbeing and Social Care, Open University, Milton Keynes, UK
• Rajvinder.samra{at}open.ac.uk

We have much to learn from established countermeasures in aviation

The coining of the term “burnout” in a clinical sense is typically attributed to the psychologist Herbert Freudenberger, 1 who in 1974 described it as particularly pertinent to caring professionals. 2 More than 40 years later, burnout is still conceptualised as uniquely affecting those in emotionally demanding professional roles. 3

However, one of the first documented reports of workplace burnout referred to people without occupational caring responsibilities. 4 In 1971, three years before Freudenberger’s description, 2 US air traffic controllers were commonly reporting “vocational ‘burn out,’ a form of exhaustion, which is manifested in a decline in quantity and quality of work production.” 4 Several important, and overlooked, parallels between burnout in air traffic controllers and in doctors can inform our current approaches to tackling this phenomenon.

During the 1960s and 1970s, air traffic controllers reported poor training environments, inadequate equipment, rapidly changing shift patterns, long shifts without breaks, fatigue, monotony due to automation, and challenges arising from human-machine interfaces. 5 A huge increase in air traffic, with a small rise in the number of controllers, pushed working conditions beyond what controllers considered to be safe. 4 5

After a series of fatal mid-air collisions linked to human error, the Federal Aviation Administration commissioned a prospective cohort study in 1973 from Boston University School of Medicine. 6 This landmark study is one of the first investigations into workplace burnout, following 416 air traffic controllers over three years and resulting in a report of over 650 pages. It identified burnout, increased incidence of hypertension, and signs that controllers developed other psychiatric problems over the course of the study. However, the report and its findings have been largely forgotten.

One of the most striking and counterintuitive aspects of the findings was that workers who went on to develop burnout had better psychological health earlier in the study, 6 scoring higher on positive mood states, reporting less anxiety and less alcohol consumption than the comparison group. The report concluded that those who feared burnout were actually the more competent individuals, and that burnout concerns, once set in motion, tended to become a self fulfilling prophecy. Burnout was not simply a failure of personal resilience: most air traffic controllers had experienced military service 6 and had dealt with extremely challenging conditions.

The study’s findings 6 can be used to question the logic underpinning recent trends in medical education and training, which emphasise the development of personal resilience as part of professional excellence. 7 The air traffic control study 6 illustrates the paradox here: workers who strive hardest to meet internal and external professional ideals may increase their risk of burnout, which then contributes to them falling short of these professional ideals. This link might represent a form of “pathological altruism,” 8 whereby people who sincerely engage in altruistic acts end up unintentionally harming themselves or those they are intending to help. Oakley argues that there might be negative consequences (such as burnout) from the unrelenting demand for altruism in healthcare professionals. 8

Coping with complexity

The history of burnout shows important links with increased work complexity. This contrasts with modern narratives that burnout among doctors mainly results from the emotional demands. 3 Changes made in aviation settings acknowledge that individual, team, organisational, regulatory, and environmental factors collectively and interactively influence performance and outcomes. 9 10

Here, crew resource management teaches skills for dealing with complexity, including team based training in situational awareness, decision making, communication, and problem solving. 10 11 This approach is also suitable in healthcare settings, where “team burnout” is associated with lower patient satisfaction with care. 12

In aviation, stress management programmes for critical incidents include preventive teaching and training on normal reactions to chronic and acute work stress (cognitive, emotional, physical, and behavioural reactions). 9 13 While interventions from aviation settings will need to be adapted to the current professional culture in medicine, 9 once embedded, they could become the mechanisms by which professional culture is changed. 9

Resource constraints and ever increasing demands and complexity are irreversibly changing professional work in medicine. A large systematic review shows that both organisational and individual interventions are effective at reducing burnout. 14 As in aviation, human factors approaches to improving systems should include interventions to manage work complexity at the individual, 13 team, 11 and organisational level. 10 Medical workloads need to be reconfigured or redesigned in line with human cognitive, emotional, and physical limitations, with accompanying organisation-wide training and management support. Active participation from the professional workforce 15 will be key to achieving success in the development of healthier and safer medical workplaces.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Not commissioned; externally peer reviewed.

• Schaufeli WB ,
• Leiter MP ,
• Freudenberger HJ
• Eisenstein L
• ↵ Calabrese JA. The Patco dispute—a need for change in public employee labor settlements. DePaul L Rev 1971;20:699-728. https://via.library.depaul.edu/law-review/vol20/iss3/4
• ↵ The PATCO Journal. December 1969 (p.36-39). Controller stress. http://digitalcollections.library.gsu.edu/cdm/ref/collection/PATCO/id/176691
• ↵ Rose RM, Jenkins CD, Hurst MW. Air traffic controller health change study. Report prepared by Boston University School of Medicine for US Dept of Transportation, FAA Office of Aviation Medicine: 1978. Report No. FAA AM-78/39. https://huntlibrary.erau.edu/collections/aerospace-and-aviation-reports/faa-medicine-reports/
• ↵ General Medical Council, Medical Schools Council. Achieving good medical practice: guidance for medical students. 2016. https://www.gmc-uk.org/-/media/documents/achieving-good-medical-practice-0816_pdf-66086678.pdf
• Müller-Leonhardt A ,
• Mitchell SG ,
• Schürmann T
• Helmreich RL ,
• Bowers CA ,
• Garman AN ,
• Corrigan PW ,
• ↵ European Organisation for the Safety of Air Navigation (EUROCONTROL). Critical incident stress management: user implementation guidelines. 2008. https://www.eurocontrol.int/sites/default/files/content/documents/nm/safety/safety-critical-incident-stress-management-user-implementation-guidelines-2008.pdf
• Dyrbye LN ,
• Shanafelt TD

clock This article was published more than  2 years ago

Burnout dominated 2021. Here’s the history of our burnout problem.

In the song “Shelter From the Storm,” recorded in 1974, Bob Dylan reels off a long litany of troubles. Among them: being “burned out from exhaustion.” The line, which appeared on the chart-topping album “Blood on the Tracks ,” distilled a significant cultural moment. The mid-1970s was when burnout as we know it first gained scientific legitimacy and broad public attention.

Today, burnout is a keyword for how we talk about our problems with work. Burnout was cited in one recent survey as the main reason record numbers of people quit their jobs in 2021. (Meanwhile, the people who stayed behind in understaffed workplaces were experiencing their own burnout.) But burnout has been with us for decades. And like Dylan’s career, its origin story is tangled up in the counterculture of Lower Manhattan.

In the early 1970s, Herbert Freudenberger, a psychologist in New York, would regularly put 10 hours a day into his private practice and then head downtown for a second shift at the St. Mark’s Free Clinic, which served the medical needs of young people living in the East Village, helping them with everything from drug addiction to dental cavities. Freudenberger had helped found the clinic in 1970 after spending the summer of 1968 at the Haight-Ashbury Free Clinic in San Francisco, ministering to hippies.

He identified strongly with his patients at the St. Mark’s clinic. “Their problems, their battles, became mine,” he later wrote. After the clinic closed for the night, he and the volunteer staff would hold meetings until the wee hours. Freudenberger would then head back uptown, get a few hours of sleep and do it all again the next day.

After about a year on this schedule, Freudenberger broke down. His daughter Lisa recalls him being unable to get out of bed on a morning the family was supposed to leave for vacation.

The term “burn-out” was already in circulation in his professional world. An official at a rehabilitation center for young adult offenders in Southern California mentioned it as a “phenomenon” among treatment staff in a 1969 paper. St. Mark’s Free Clinic workers used the term to describe themselves, but they may have picked it up from the East Village streets, where people used it to describe heroin users’ veins: Inject into a spot long enough, and it becomes useless, burned out. In a 1980 book, Freudenberger compared “Burn-Outs” like himself to burned-out buildings.

To understand what had happened to him, Freudenberger turned his psychoanalytic training on himself. He spoke into a tape recorder, then played the tape back, as if he were his own patient. In 1974, he published a paper titled “Staff Burn-Out” in an academic journal. In the paper, Freudenberger asked, “Who is prone to burn-out?” His answer was unambiguous: “The dedicated and the committed.” Free Clinic staff offered “our talents, our skills, we put in long hours with a bare minimum of financial compensation,” Freudenberger wrote. “But it is precisely because we are dedicated that we walk into a burn-out trap. We work too long and too intensely. We feel a pressure from within to work and help and we feel a pressure from the outside to give.”

Freudenberger’s analysis of burnout was unscientific and not rigorously worked out. He didn’t have a survey or a scale for measuring burnout, only limited observations that, for instance, people typically burned out after about a year working at the clinic. His language merged psychoanalytic jargon with counterculture lingo. He dropped ’70s slang like “speed freaks” and “self con” and used “bad rap” as a verb.

Freudenberger’s list of burnout symptoms was wide: “exhaustion, being unable to shake a lingering cold, suffering from frequent headaches and gastrointestinal disturbances, sleeplessness and shortness of breath,” as well as “quickness to anger,” paranoia, overconfidence, cynicism and isolation. In short, burnout was everywhere, because anything could be burnout.

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Around the time Freudenberger was pulling double shifts in New York, Christina Maslach was on the other side of the country, trying to convince psychologist Philip Zimbardo to put a stop to his now-infamous Stanford Prison Experiment, in which students were asked to role-play as inmates and guards in a mocked-up prison for a planned two weeks.

In the summer of 1971, Maslach had just completed her PhD at Stanford and was dating Zimbardo. When she visited the prison site on its fifth day, she was horrified by the brutality ordinary-seeming college students could inflict on each other, with “guards” physically humiliating “prisoners” and placing them in solitary confinement. When she spoke with Zimbardo that evening, she later recounted: “I started to scream, I started to yell, ‘I think it is terrible what you are doing to those boys!’ ” Zimbardo ended the experiment the next morning.

Maslach, who married Zimbardo in 1972, soon began studying a similar phenomenon in human-services work: “how people who are responsible for the care and treatment of others can come to view those they care for in object-like ways.” She found that “detached concern” is a crucial mode for caregivers, though different professions approach it in different ways. While the norms of health-care work demand an attitude that combines sympathetic concern with clinical objectivity, human-service workers typically engage emotionally with their clients, only to find that, over time, the work drains them.

Detachment is a protective strategy, she wrote in 1973, but “if the detachment becomes too extreme, the service professional experiences ‘burn-out,’ a phrase which is used by poverty lawyers to describe the loss of any human feeling for their clients.” Maslach’s report preceded Freudenberger’s paper by only a few months. Burnout was a simultaneous discovery whose influence soon grew well beyond research papers and became a cultural buzzword, much as it is today.

After World War II, tens of thousands of U.S. soldiers mutinied — and won

It can’t be coincidence that Freudenberger and Maslach independently “discovered” burnout in 1973-74. Something was happening in American society that they both detected. Dylan picked up on it, too. So did Neil Young in early 1974, singing of “burn-outs” aimlessly dragging their feet in his song “Ambulance Blues.” What was going on that made burnout just the right word to make sense of this cultural moment?

The broken idealism of the 1960s may have played a role. The counterculture of the era — including, surely, people Freudenberger worked with at the St. Mark’s Free Clinic — imagined ways of living that did not place 9-to-5 work at the center. But by the 1970s, it had made little dent in the establishment. Thousands of optimistic and well-educated people went into human-service careers, motivated to win the “War on Poverty,” only to discover how intractable society’s problems were, and how much time they would spend ensnared in bureaucracy.

As important as those disappointed ideals may be to the emergence of burnout in the early 1970s, there was a still bigger factor involved. Burnout first came to public attention at a critical transition point in the history of work in America. With decades of hindsight, historians now see 1974 as “a watershed between eras,” as Jefferson Cowie puts it in “ Stayin’ Alive ,” his book on the 1970s working class. Prior to 1974, the New Deal consensus on labor still reigned: If productivity increased, so would workers’ wages. Accordingly, the real wages of rank-and-file workers steadily rose, reaching their peak in 1973.

This did not mean an absence of conflict within the labor movement, though. A younger generation of union members wanted to fight against the fast pace and deadening repetition of work on the lines. Their elders argued that they already had favorable contracts, so why did they want to agitate against boredom?

Still, an internal debate over the quality of work signaled a labor movement with real power. It wouldn’t last.

After 1974, the mid-century golden age crumbled. The ignominious ends of the Nixon presidency and the Vietnam War shook Americans’ faith in their political institutions. American manufacturing and organized labor drowned in a toxic brew of global competition, the “oil shock” resulting from an OPEC embargo and rapid inflation. For the first time since World War II, workers’ productivity gains became detached from their wages.

Since 1974, labor productivity has kept increasing, but workers’ compensation has not. Real wages for nonsupervisory employees actually declined in the 1970s and 80s, and, aside from a temporary uptick caused by the coronavirus pandemic’s effect on the workforce, they still have still not recovered. “The continuous readjustment of expectations — downward: that was a key experience of the 1970s,” writes historian Rick Perlstein.

The problems facing the United States in the 1970s weren’t just political or economic; they were emotional. Historians and contemporary observers called the events of the middle of the decade a national “nervous breakdown,” “a collective sadness.” The decade ended with President Jimmy Carter diagnosing the whole country with a chronic spiritual sickness in a televised address that has come to be known as the “malaise speech.”

America had become a burnout case: exhausted, cynical and consumed by a feeling of uselessness.

At the dawn of the 1980s, burnout became a key term to describe the condition of frazzled, defeated American workers. Maslach soon developed a theory of burnout’s institutional causes, and Freudenberger’s 1980 book “Burn-Out: The High Cost of High Achievement” became a popular self-help guide. In 1981, the president of the air traffic controllers’ union cited “early burnout” as the first reason union members were going on strike for higher wages and a shorter workweek.

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The strike was a moment of optimism in the fight against burnout; it must have seemed possible to cure the condition through collective action. When President Ronald Reagan fired 11,000 controllers for refusing his return-to-work order, that hope was extinguished. Reagan’s decision sent a message that workers still hear today: They will deal with burnout on their own, or not at all. A year later, the term had apparently become so commonplace that William Safire declared in his New York Times “On Language” column that it was itself “undergoing linguistic burnout.”

Even as research on burnout grew in the 1990s and 2000s, the term went into a two-decade dormant period in the United States. Meanwhile, it traveled overseas. Maslach and two co-authors observed in a 2009 paper that “roughly speaking, the order in which the interest in burnout seems to have spread corresponds with the economic development of the countries involved.” That is, burnout began as a concern of wealthy North American and European countries, then propagated to Latin America, Africa and Asia.

In 2019, burnout was classified as a “syndrome,” though not an illness, in the World Health Organization’s main compendium of diagnoses, the International Classification of Diseases. In a few European countries, including Sweden, burnout is an official diagnosis that can entitle its sufferers to paid time off and other sickness benefits. In Finland, burned-out workers can qualify for paid rehabilitation workshops that feature 10 days of intensive individual and group activities, including counseling, exercise and nutrition classes.

Even as awareness of burnout has grown, public and scientific understanding of the condition has not progressed much. There is still little consensus on how to measure burnout and no widely acknowledged means to diagnose it. Burnout has no status as a disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual. We still hear echoes of Freudenberger’s vague, catchall list of symptoms decades later.

In 1980, Freudenberger attributed burnout to the fast pace of social and economic change, from the sexual revolution to consumerism. “At the same time,” he wrote, “TV has exposed us to alluring pictures of people leading the ‘good life.’” Substitute Instagram for television, and it could have been published yesterday.

This story is adapted from “The End of Burnout: Why Work Drains Us and How to Build Better Lives ,” by Jonathan Malesic, which will be published by the University of California Press on Jan. 4.

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I won’t make the same mistake again: burnout history and job preferences

• Original Paper
• Published: 23 January 2024
• Volume 37 , article number  2 , ( 2024 )

Cite this article

• Philippe Sterkens 1 ,
• Stijn Baert   ORCID: orcid.org/0000-0002-1660-5165 1 , 2 , 3 ,
• Eline Moens 1 ,
• Joey Wuyts 1 &
• Eva Derous 4  

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The burnout literature has focused on the determinants of burnout, whereas its careers consequences remain understudied. Therefore, we investigate whether recently burned-out individuals differ in job preferences from non-burned-out workers. We link these differences in preferences with (1) perceptions of job demands and resources, as well as (2) the weighting of such perceptions. To this end, a sample of 582 employees varying in their history of burnout judged job offers with manipulated characteristics in terms of their willingness to apply as well as perceived job demands and resources. We find that recently burned-out employees appreciate possibilities to telework and fixed feedback relatively more, while being relatively less attracted to learning opportunities. These findings can be partially explained by differences in the jobs’ perceived resources.

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Data availability.

The data that support the findings of this study are available from the corresponding author upon request.

Policy-capturing, factorial survey experiment and conjoint analysis are all very closely related traditions of vignette techniques that are used in the social sciences (Aguinis and Bradley 2014 ; Weijters et al. 2021 ).

To construct an ecologically valid set of vacancies for participants to rate, we allowed full-time jobs to appear in 50% of the vignettes because full-time jobs are still more common than part-time jobs. The remaining half of the vignettes consisted of 25% half-time jobs and 25% 4/5ths jobs.

In the analyses including control variables, up to 10 participants were excluded from the sample because they failed to provide data for all control variables.

An additional screening question was included that asked whether the participant was currently ‘employed’ ( n  = 582), ‘unemployed’ ( n  = 80) or ‘self-employed’ ( n  = 7). Only participants who answered ‘employed’ were allowed to continue the survey and could provide their informed consent to study participation.

An article revising the psychological capital scale was published on 3 March 2021 (Dudasova et al. 2021 ). Because we sent out our survey on 9 March 2021, we were unable to implement the revised scale before rolling out the survey.

The significance of other terms did change after adding control variables in addition to the interactions. However, this is not unexpected, given that these terms now represent very specific reference categories. Moreover, analysing the wage variable via a continuous variable instead of dummy-variables did not change our conclusions.

Abraham M, Auspurg K, Bähr S, Frodermann C, Gundert S, Hinz T (2013) Unemployment and willingness to accept job offers: results of a factorial survey experiment. J Labour Mark Res 46(4):283–305. https://doi.org/10.1007/s12651-013-0142-1

Article   Google Scholar  

Aguinis H, Bradley KJ (2014) Best practice recommendations for designing and implementing experimental vignette methodology studies. Organ Res Methods 17(4):351–371. https://doi.org/10.1177/1094428114547952

Auspurg K, Hinz T (2014) Factorial survey experiments. Sage Publications, Thousand Oaks

Google Scholar  

Baert S, Rotsaert O, Verhaest D, Omey E (2016) Student employment and later labour market success: no evidence for higher employment chances. Kyklos 69(3):401–425. https://doi.org/10.1111/kykl.12115

Bakker AB, de Vries JD (2021) Job demands–resources theory and self-regulation: new explanations and remedies for job burnout. Anxiety Stress Coping 34(1):1–21. https://doi.org/10.1080/10615806.2020.1797695

Article   PubMed   Google Scholar  

Bakker AB, Demerouti E (2007) The job demands-resources model: state of the art. J Manag Psychol 22(3):309–328. https://doi.org/10.1108/02683940710733115

Bakker AB, Demerouti E, Verbeke W (2004) Using the job demands-resources model to predict burnout and performance. Hum Resour Manage 43(1):83–104. https://doi.org/10.1002/hrm.20004

Bakker AB, Van Der Zee KI, Lewig KA, Dollard MF (2006) The relationship between the big five personality factors and burnout: a study among volunteer counselors. J Soc Psychol 146(1):31–50. https://doi.org/10.3200/SOCP.146.1.31-50

Bakker AB, Demerouti E, Taris T, Schaufeli WB, Schreurs P (2003) A multi-group analysis of the job demands–resources model in four home care organizations. Int J Stress Manag 10:16–38. https://psycnet.apa.org/doi/10.1037/1072-5245.10.1.16

Bakker AB, Demerouti E, Euwema MC (2005) Job resources buffer the impact of job demands on burnout. J Occup Health Psychol 10(2): 170. https://psycnet.apa.org/doi/10.1037/1076-8998.10.2.170

Bakker AB, Demerouti E, Sanz-Vergel AI (2014) Burnout and work engagement: The JD–R approach. Annu Rev Organ Psychol Organ Behav 1(1):389–411. https://doi.org/10.1146/annurev-orgpsych-031413-091235

Boštjančič E, Galič K (2020) Returning to work after sick leave–the role of work demands and resources, self-efficacy, and social support. Front Psychol 11. https://doi.org/10.3389/fpsyg.2020.00661

Boštjančič E, Koračin N (2014) Returning to work after suffering from burnout syndrome: Perceived changes in personality, views, values, and behaviors connected with work. Psihologija 47(1):131–147. https://doi.org/10.2298/PSI1401131B

Brotheridge CM, Grandey AA (2002) Emotional labor and burnout: comparing two perspectives of “people work.” J Vocat Behav 60(1):17–39. https://doi.org/10.1006/jvbe.2001.1815

Charalampous M, Grant CA, Tramontano C, Michailidis E (2019) Systematically reviewing remote e-workers’ well-being at work: a multidimensional approach. Eur J Work Organ Psy 28(1):51–73. https://doi.org/10.1080/1359432X.2018.1541886

Charoensukmongkol P, Moqbel M, Gutierrez-Wirsching S, Shankar R (2016) The role of coworker and supervisor support on job burnout and job satisfaction. J Adv Manag Res 13(1). https://doi.org/10.1108/JAMR-06-2014-0037

Chung H, Van der Lippe T (2020) Flexible working, work–life balance, and gender equality: introduction. Soc Indic Res 151(2):365–381. https://doi.org/10.1007/s11205-018-2025-x

Cottini E, Lucifora C (2013) Mental health and working conditions in Europe. ILR Rev 66(4):958–988. https://doi.org/10.1177/00197939130660040

Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB (2000) A model of burnout and life satisfaction amongst nurses. J Adv Nurs 32(2):454–464. https://doi.org/10.1046/j.1365-2648.2000.01496.x

Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB (2001) The job demands-resources model of burnout. J Appl Psychol 86(3):499. https://doi.org/10.1037//0021-9010.86.3.499

Donnellan MB, Oswald FL, Baird BM, Lucas RE (2006) The mini-IPIP scales: tiny-yet-effective measures of the Big Five factors of personality. Psychol Assess 18(2), 192. https://psycnet.apa.org/doi/10.1037/1040-3590.18.2.192

Dormann C, Zapf D (2004) Customer-related social stressors and burnout. J Occup Health Psychol 9(1):61. https://psycnet.apa.org/doi/10.1037/1076-8998.9.1.61

Dudasova L, Prochazka J, Vaculik M, Lorenz T (2021) Measuring psychological capital: revision of the Compound Psychological Capital Scale (CPC-12). PLoS ONE 16(3):e0247114. https://doi.org/10.1371/journal.pone.0247114

Article   PubMed   PubMed Central   Google Scholar  

Fischer DG, Fick C (1993) Measuring social desirability: short forms of the Marlowe-Crowne social desirability scale. Educ Psychol Meas 53(2):417–424. https://doi.org/10.1177/0013164493053002011

Grossi G, Perski A, Osika W, Savic I (2015) Stress-related exhaustion disorder–clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol 56(6):626–636. https://doi.org/10.1111/sjop.12251

Hackman JR, Oldham GR (1980) Work redesign. Addison-Wesley, Reading, MA

Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus, L. C., ... & Goh, J. (2019). Estimating the attributable cost of physician burnout in the United States. Ann Int Med 170(11):784–790. https://doi.org/10.7326/M18-1422

Hansson E, Mattisson K, Björk J, Östergren PO, Jakobsson K (2011) Relationship between commuting and health outcomes in a cross-sectional population survey in southern Sweden. BMC Public Health 11(1):1–14. https://doi.org/10.1186/1471-2458-11-834

Herbert M (2011) An exploration of the relationships between psychological capital (hope, optimism, self-efficacy, resilience), occupational stress, burnout and employee engagement (Doctoral dissertation, Stellenbosch: Stellenbosch University). http://hdl.handle.net/10019.1/17829 . Accessed 14 Jun 2021

Hu NC, Chen JD, Cheng TJ (2016) The associations between long working hours, physical inactivity, and burnout. J Occup Environ Med 58(5):514–518. https://doi.org/10.1097/JOM.0000000000000715

Huber MT, Ham SA, Qayyum M, Akkari L, Olaosebikan T, Abraham J, Yoon JD (2018) Association between job factors, burnout, and preference for a new job: a nationally representative physician survey. J Gen Intern Med 33(6):789–791. https://doi.org/10.1007/s11606-018-4412-z

Jung D, Tang KK, Yazbeck M (2022) Poor job conditions amplify negative mental health shocks. Labour Econ 79:102257

Kärkkäinen R, Saaranen T, Hiltunen S, Ryynänen OP, Räsänen K (2017) Systematic review: factors associated with return to work in burnout. Occup Med 67(6):461–468. https://doi.org/10.1093/occmed/kqx093

Lee RT, Ashforth BE (1996) A meta-analytic examination of the three dimensions of burnout. J Appl Psychol 81(2):123–133. https://doi.org/10.1037/0021-9010.81.2.123

Leiter MP, Maslach C, Frame K (2015) Burnout. Encycl of Clin Psychol 1–7. https://doi.org/10.1002/9781118625392.wbecp142

Leiter MP, Maslach C (2003) Areas of worklife: a structured approach to organizational predictors of job burnout. Res Occup Stress Well Being 3:91–134. https://doi.org/10.1016/S1479-3555(03)03003-8

Liljegren M, Ekberg K (2009) Job mobility as predictor of health and burnout. J Occup Organ Psychol 82(2):317–329. https://doi.org/10.1348/096317908X332919

Lorenz T, Beer C, Pütz J, Heinitz K (2016) Measuring psychological capital: construction and validation of the compound PsyCap scale (CPC-12). Plos One 11(4). https://doi.org/10.1371/journal.pone.0152892

Mandrik CA, Bao Y (2005) Exploring the concept and measurement of general risk aversion. ACR North Am Adv 32:531–539. http://www.acrwebsite.org/volumes/9140/volumes/v32/NA-32

Mangham LJ, Hanson K, McPake B (2009) How to do (or not to do)… designing a discrete choice experiment for application in a low-income country. Health Policy Plan 24(2):151–158. https://doi.org/10.1093/heapol/czn047

Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422. https://doi.org/10.1146/annurev.psych.52.1.397

Moens E, Lippens L, Sterkens P, Weytjens J, Baert S (2021) The COVID-19 crisis and telework: a research survey on experiences, expectations and hopes. Eur J Health Econ 23:1–25. https://doi.org/10.1007/s10198-021-01392-z

Moens E, Verhofstadt E, Van Ootegem L, Baert S (2022) Disentangling the attractiveness of telework to employees: a factorial survey experiment. IZA Discussion Paper No. 15190 . https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4114763

Reineholm C, Gustavsson M, Liljegren M, Ekberg K (2012) The importance of work conditions and health for voluntary job mobility: a two-year follow-up. BMC Public Health 12(1):1–7. https://doi.org/10.1186/1471-2458-12-682

Riziv (2020) Langdurige arbeidsongeschiktheid: Hoeveel langdurige burn-outs en depressies? Hoeveel kost dat aan uitkeringen? https://www.inami.fgov.be/nl/statistieken/uitkeringen/Paginas/langdurige-arbeidsongeschiktheid-burnout-depressie.aspx . Accessed 14 Jul 2021

Rooman C, Sterkens P, Schelfhout S, Van Royen A, Baert S, Derous E (2021). Successful return to work after burnout: an evaluation of job, person-and private-related burnout determinants as determinants of return-to-work quality after sick leave for burnout. Disabil Rehabil 1–10. https://doi.org/10.1080/09638288.2021.1982025

Sardeshmukh SR, Sharma D, Golden TD (2012) Impact of telework on exhaustion and job engagement: a job demands and job resources model. N Technol Work Employ 27(3):193–207. https://doi.org/10.1111/j.1468-005X.2012.00284.x

Scanlan JN, Still M (2019) Relationships between burnout, turnover intention, job satisfaction, job demands and job resources for mental health personnel in an Australian mental health service. BMC Health Serv Res 19(1):1–11. https://doi.org/10.1186/s12913-018-3841-z

Schaufeli WB, Bakker AB (2004) Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. J Organ Behav 25(3):293–315

Schaufeli WB, Desart S, De Witte H (2020) Burnout Assessment Tool (BAT)—development, validity, and reliability. Int J Environ Res Public Health 17(24):9495. https://doi.org/10.3390/ijerph17249495

Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM (2019) Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics 37(2):201–226. https://doi.org/10.1007/s40273-018-0734-2

Sterkens P, Baert S, Rooman C, Derous E (2021) As if it weren’t hard enough already: breaking down hiring discrimination following burnout. Econ Hum Biol 43:101050. https://doi.org/10.1016/j.ehb.2021.101050

Sterkens P, Baert S, Rooman C, Derous E (2022) Why making promotion after a burnout is like boiling the ocean. Eur Sociol Rev jcac055. https://doi.org/10.1093/esr/jcac055

Su D, Steiner PM (2020) An evaluation of experimental designs for constructing vignette sets in factorial surveys. Sociol Methods Res 49(2):455–497. https://doi.org/10.1177/0049124117746427

Article   MathSciNet   Google Scholar  

Taylor-Gooby P, Zinn JO (2006) Current directions in risk research: new developments in psychology and sociology. Risk Anal Int J 26(2):397–411. https://doi.org/10.1111/j.1539-6924.2006.00746.x

Tims M, Bakker AB, Derks D (2015) Job crafting and job performance: a longitudinal study. Eur J Work Organ Psy 24(6):914–928. https://doi.org/10.1080/1359432X.2014.969245

Tims M, Bakker AB (2010) Job crafting: towards a new model of individual job redesign. SA J Ind Psychol 36(2):1–9. https://hdl.handle.net/10520/EJC89228

Tomassetti AJ, Dalal RS, Kaplan SA (2016) Is policy capturing really more resistant than traditional self-report techniques to socially desirable responding? Organ Res Methods 19(2):255–285. https://doi.org/10.1177/1094428115627497

Treischl E, Wolbring T (2022) The past, present and future of factorial survey experiments: a review for the social sciences. Methods, Data, Anal 16(2) 141–170. https://doi.org/10.12758/mda.2021.07

Valet P, Sauer C, Tolsma J (2021) Preferences for work arrangements: a discrete choice experiment. PLoS ONE 16(7):1–20. https://doi.org/10.1371/journal.pone.0254483

van Huizen T, Alessie R (2019) Risk aversion and job mobility. J Econ Behav Organ 164:91–106. https://doi.org/10.1016/j.jebo.2019.01.021

Weigl M, Stab N, Herms I, Angerer P, Hacker W, Glaser J (2016) The associations of supervisor support and work overload with burnout and depression: a cross-sectional study in two nursing settings. J Adv Nurs 72(8):1774–1788. https://doi.org/10.1111/jan.12948

Weijters B, Davidov E, Baumgartner H (2021) Analyzing factorial survey data with structural equation models. Sociol Methods Res 0(0): 1–33. https://doi.org/10.1177/00491241211043139

Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K (2019) Burnout and health care workforce turnover. Annal Fam Med 17(1):36–41. https://doi.org/10.1370/afm.2338

Woo T, Ho R, Tang A, Tam W (2020) Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis. J Psychiatr Res 123:9–20. https://doi.org/10.1016/j.jpsychires.2019.12.015

Zis P, Anagnostopoulos F, Sykioti P (2014) Burnout in medical residents: a study based on the job demands-resources model. Sci World J 2014. https://doi.org/10.1155/2014/673279

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Philippe Sterkens, Stijn Baert, Eline Moens & Joey Wuyts

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Sterkens, P., Baert, S., Moens, E. et al. I won’t make the same mistake again: burnout history and job preferences. J Popul Econ 37 , 2 (2024). https://doi.org/10.1007/s00148-024-00980-6

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Cover Story

Burnout and the brain.

• Cognitive Neuroscience
• Cognitive Processes
• Endocrinology
• Experimental Psychology
• Health Effects of Stress
• Heart Disease
• Neuroendocrinology
• Work Life Balance

One of the greatest threats to workplace safety may be from an unexpected source: stress. Just a few years after launching the Huffington Post media empire, company president and editor-in-chief Arianna Huffington was so exhausted from running her new business that she collapsed.

“I hit my head on my desk, broke my cheek bone, got four stitches on my right eye,” Huffington disclosed during an interview with Oprah Winfrey. “I was very lucky I didn’t lose my eye.”

Global surveys on the state of the working world show that a large proportion of people share the experience that Huffington described. Indeed, burnout arguably is reaching epic proportions in many industrialized countries. Recent Gallup research, for example, showed that 2.7 million workers in Germany report feeling the effects of burnout. A 2013 survey of human resource directors in the United Kingdom found that nearly 30% reported that burnout was widespread within their organization.

It’s a mistake to assume that burnout is merely an emotional response to long hours or a challenging job. Rather, mounting scientific evidence shows that burnout takes a profound physical toll that cascades well beyond our professional lives. Using cutting-edge techniques, integrative research teams are demonstrating that burnout is not just a state of mind, but a condition that leaves its mark on the brain as well as the body.

Just as the impact of burnout stifles healthy professional growth, emerging research shows that the chronic psychosocial stress that characterizes burnout not only impairs people’s personal and social functioning, it also can overwhelm their cognitive skills and neuroendocrine systems — eventually leading to distinctive changes in the anatomy and functioning of the brain.

Burnout Begins

The psychologist Herbert Freudenberger is credited with bringing the term “burnout” into the research lexicon in 1974, defining it as the loss of motivation, growing sense of emotional depletion, and cynicism he observed among volunteers working at a free clinic in New York City. Formerly idealistic mental health workers were finding themselves depleted and weary, resenting patients and the clinic.

Burnout is now recognized as a legitimate medical disorder by much of mainstream medicine and has even been given its own ICD-10 code (Z73.0 – Burn-out state of vital exhaustion). Many of the symptoms of burnout overlap with the hallmarks of depression, including extreme fatigue, loss of passion, and intensifying cynicism and negativity.

APS Fellow Christina Maslach, professor emerita at the University of California, Berkeley, and one of the foremost researchers on burnout, began studying this emerging phenomenon in the 1970s through a series of extensive interviews with employees in service organizations. In analyzing the interviews, Maslach and colleagues noticed a trend: Workers often reported feelings of profound emotional exhaustion, negativity directed at clients and patients, and a crisis in feelings of professional competence. Much like symptoms of depression, burnout was asphyxiating people’s ambitions, idealism, and sense of worth.

The 1976 publication of Maslach’s article “Burned-Out,” published in the magazine Human Behavior , generated a huge public response — popularizing the concept of burnout within the popular press. Maslach received an incredible outpouring of letters and phone calls from people who were grateful to find out that they were not alone in their experience of burnout.

“I had not expected at all that kind of reaction,” Maslach said. “The impact of that article was just huge.” The article led to more research, more books, and more attention from academic journals.

Maslach and APS Fellow Susan E. Jackson (Rutgers University) collaborated on what would become the most influential framework for defining and assessing burnout. Published in 1981, the original paper describing the Maslach Burnout Inventory has been cited well over 6,000 times to date, according to Google Scholar. The scale evaluates burnout based on three key stress responses: an overwhelming sense of exhaustion, feelings of cynicism and detachment, and a sense of professional ineffectiveness and lack of accomplishment.

At its core, burnout emerges when the demands of a job outstrip a person’s ability to cope with the stress. People in careers focused on caregiving — teachers, nurses, social workers, and physicians — report the most prevalent rates of burnout, but the condition ultimately doesn’t discriminate among call center representatives, professional athletes, or CEOs. Over time, jobs that require too much of employees will cultivate feelings of negativity and hopelessness as people struggle to meet impossible deadlines, deal with rude customers, or cope with the emotional toll of professional caretaking.

It’s a common misconception that the culprit behind burnout is simply working too long or too hard — research indicates that other factors, both individual and organizational, can be just as detrimental. For example, a comprehensive report on psychosocial stress in the workplace published by the World Health Organization identified consistent evidence that “high job demands, low control, and effort–reward imbalance are risk factors for mental and physical health problems.” Ultimately, burnout results when the balance of deadlines, demands, working hours, and other stressors outstrips rewards, recognition, and relaxation.

Over the past 20 years, Maslach and her collaborators have developed a comprehensive model identifying six key components of the workplace environment that contribute to burnout: workload, control, reward, community, fairness, and values. Burnout emerges when one or more of these six areas is chronically mismatched between an individual and his job. Over time, Maslach explained, passion erodes not only because people have too much to do, but because of these other factors.

Richard Gunderman, a physician who serves as a professor of radiology and philosophy at Indiana University, described the incremental onset of burnout as “the accumulation of hundreds or thousands of tiny disappointments, each one hardly noticeable on its own.”

A Vicious Cycle

New research is showing just how devastating this kind of occupational stress can be to the brain.

Research from an integrative team of psychological scientists at the Karolinska Institutet in Sweden provides striking evidence that workplace burnout can alter neural circuits, ultimately causing a vicious cycle of neurological dysfunction.

Lead author Armita Golkar and colleagues recruited a group of 40 subjects with formally diagnosed burnout symptoms from the Stress Research Institute at Stockholm University, Sweden. All of the participants attributed their symptoms to stressful working conditions, entailing more than 60 to 70 hours of work per week continuously for several years. The researchers also recruited a socioeconomically matched control group made up of 70 healthy volunteers with no history of chronic stress or other illnesses.

Each group of participants completed two test sessions: a task designed to measure their ability to regulate their negative emotions and an evaluation of their brain’s connectivity using resting-state functional MRI (R-fMRI).

To assess reactions to stress, researchers showed participants a standardized series of neutral and negative emotional images. After a participant looked at an image for 5 seconds, a set of instructions appeared on the screen, directing each participant to either suppress (down-regulate), intensify (up-regulate), or maintain her emotional response to the picture. Immediately following this instruction cue, the same image was presented again for another 5 seconds.

As the participant focused on the picture, a loud, startling burst of sound played. An electrode taped to the participant’s cheek recorded the reflex reactions to this stressful stimulus.

The two groups showed similar startle responses when they were instructed to maintain or intensify their emotional reactions. However, when the groups were asked to down-regulate their emotional responses to negative images, clear differences emerged.

Those diagnosed with burnout reported more difficulty modulating their strong negative emotional responses compared with the healthy controls, which was confirmed by their physical responses: They had dramatically stronger reactions to the startling noise than did the control group.

On a different day, a subset of the participants came into the lab, where they were scanned while lying quietly. The researchers focused on activity among several brain areas involved in processing and regulating emotions.

The two groups showed key differences in the amygdala — a brain structure that is critical in emotional reactions including fear and aggression. Participants in the burnout group had relatively enlarged amygdalae, and also appeared to have significantly weaker connections between the amygdala and brain areas linked to emotional distress, specifically the anterior cingulate cortex (ACC). The more stressed an individual reported feeling, the weaker the connectivity between these brain regions appeared on the R-fMRI.

Compared with the control group, the overworked group also showed weaker correlations between activity in the amygdala and the medial prefrontal cortex (mPFC), a structure involved in executive function. Weaker connections between these two brain structures could help explain why participants in the burnout group had more difficulty controlling their negative emotions.

In another study, Ivanka Savic, a neurologist in the Department of Women’s and Children’s Health at the Karolinska Institutet, confirmed that the brains of individuals suffering from burnout don’t just function differently — their very structure may change.

Supporting the functional findings of the collaboration with Golkar, Savic found anatomical evidence that the brains of burnout patients were showing signs of chronic stress. Savic anticipated that chronic stress would be visible in brain areas involved in the modulation of stress responses — the amygdala, the ACC, and the mPFC.

Savic matched a group of 40 subjects reporting symptoms of burnout to a group of 40 healthy controls. She used the Maslach Burnout Inventory to measure participants’ degree of burnout and took MRI-based measurements of cortical thickness and amygdala, ACC, and mPFC volumes to gauge the physical toll of stress.

The results suggest that the emotional turmoil of burnout leaves a signature mark in these brain structures. The frontal cortex, a brain area essential to cognitive functioning, begins to thin as part of the normal aging process, but patients suffering from burnout showed more pronounced thinning in the mPFC compared with the controls. The normal effects of aging were also more prominent in the scans of the burnout group.

Other brain structures also showed signs of wear and tear: Burnout patients appeared to have larger amygdalae and shrinking in the caudate, which correlated with their perceptions of workplace stress.

Savic theorizes that overactivation in the amygdala leads to impaired modulation of the mPFC regions, which then triggers further stimulation of the amygdala — leading to even more activation of the mPFC. As this cycle spirals further out of control over time, neural structures begin to show signs of wear and tear, which lead to cortical thinning as well as memory, attentional, and emotional difficulties.

In a collaboration with another team of Karolinska Institutet stress researchers, Savic and colleagues concluded that long-term occupational stress also was linked with significant reductions in gray-matter volumes in the hippocampus, caudate, and putamen — structures known to be susceptible to neurotoxic changes arising from the excessive release of glutamate.

“Data from animal experiments show that stress causes an enhanced release of glutamate, and that a stress-related elevation of extracellular glutamate levels induces retraction in the spines in stress-targeted regions, such as the mPFC, the anterior cingulate, and the basal ganglia,” Savic and colleagues explain.

Neuroimaging studies of people who have experienced severe early-life trauma have revealed that their brains show similar patterns to the brains of people suffering from clinical burnout. Regardless of the underlying cause, evidence is accumulating to suggest that the neuronal circuits can be damaged by both situations of extreme trauma and by accumulated everyday stress.

Cognitive Costs

Beyond changes to the brain’s anatomy, scientists are beginning to understand how burnout can affect people’s cognitive functioning — disrupting creativity, problem solving, and working memory.

To get a better understanding of the cognitive costs of burnout, a team of Greek psychological scientists led by Pavlos Deligkaris (Aristotle University of Thessaloniki, Greece) conducted a comprehensive review of the burnout literature. Ultimately, 15 studies met the strict inclusion criteria: Articles had to be in English, include measures specific to burnout (regardless of assessment scale used), and assess cognitive functions with a validated psychometric measure.

In 13 of the 15 studies, burnout was associated with cognitive deficits. Deligkaris and colleagues reported that “specifically, executive attentional and memory systems appear to suffer in association with burnout, and cognitive functioning is impaired in burned-out individuals.” Of the seven studies assessing sustained or controlled attention, five indicated that individuals with burnout were more prone to attentional lapses. Out of the seven studies that included assessments of memory, six showed an association between burnout and memory impairments.

However, the researchers caution that nearly all of these studies were both small and cross-sectional, making it difficult to pinpoint burnout as the cause of any cognitive impairments. It’s also possible that individuals who have low executive functioning to begin with end up being more vulnerable to the negative effects of stress — ultimately resulting in higher rates of burnout.

Biometrics of Burnout

In addition to dysregulation in brain function, emerging evidence suggests that — much like other chronic stress conditions — burnout also leads to turmoil within the regulation of the body’s neuroendocrine system. The hypothalamic–pituitary–adrenal (HPA) axis is an important component in the regulation of the stress response, controlling the release of the “stress hormone” cortisol.

Under normal conditions, when we perceive a threat — whether it’s a snake in the grass or an upcoming deadline — a rush of cortisol is released into the body.

Once released into the bloodstream, cortisol triggers potent reactions throughout the entire body, ranging from cardiovascular activity to the immune system and memory formation. Once the threat has passed, cortisol levels fall off, and these systems return to baseline levels. However, when stress becomes chronic — as in the case of burnout — the body fails to return to normal, leading to a cascade of potential health problems.

Under conditions of prolonged stress, the HPA axis ceases to produce higher-than-normal levels of cortisol: When cortisol levels remain too high for too long, the body responds by eventually downshifting cortisol production to abnormally low levels, a state called hypocortisolism. These abnormally low levels of cortisol are associated with severe stress and trauma, as though the body’s stress response system itself has been burned out.

A team led by Bart Oosterholt (Radboud University Nijmegen, the Netherlands) investigated the relationship between HPA-axis functioning and burnout symptoms. They recruited both a group of patients with a formal clinical diagnosis of burnout and a group of nonclinical patients with burnout symptoms but no formal diagnosis. An analysis of saliva samples showed that both burnout groups had significantly lower morning cortisol levels compared with a group of healthy control subjects — a sign that their bodies were responding to long-term stressors.

Additional research suggests that hypocortisolism induces low-grade inflammation throughout the body, which in turn contributes to severe health problems, including buildup of plaque in the coronary arteries. One large study of nearly 9,000 employed adults found that burnout was a significant risk factor for developing coronary heart disease, which can lead to heart attacks.

The team of researchers, led by Sharon Toker, head of the organizational behavior department of Tel Aviv University, Israel, tracked the routine health screenings of 8,838 employees for an average of 3.4 years. They found that employees who scored in the top 20% on the burnout scale at baseline had a 79% increased risk of being diagnosed with coronary heart disease over the course of the study.

Coronary heart disease is the most common type of heart disease, killing more than 370,000 people each year just in the United States, according to the Centers for Disease Control and Prevention. Although public health efforts to prevent heart disease most often focus on lifestyle factors such as diet and exercise, the stresses of a grinding workday may be just as detrimental as lighting up a cigarette or eating a double-bacon cheeseburger.

Can Burnout Be Reversed?

APS William James Fellow Bruce McEwen (The Rockefeller University) researches the interplay of stress hormones, the brain, and the body. His research on the neuroendocrinology of stress hormones has shown how chronic stress impacts specific areas of the brain — leading to the changes in mood, learning, and memory that are the hallmarks of burnout.

McEwen, along with APS Fellow BJ Casey and psychiatrist Conor Liston, both of Weill Cornell Medical College, has found promising initial evidence that the negative effects of chronic stress may be reversible.

The research team recruited a group of severely stressed-out medical students. The 20 students were studying to take one of the most important tests of their lives — the US medical licensing exam. Students cannot practice medicine until they pass this exam. The researchers also recruited a group of relatively unstressed medical students as a control group.

Previous research in animal models found that rats subjected to chronic stress showed impairments in attention-shifting tasks, as well as signs of shrinkage and damage to neurons in the mPFC, a brain region involved in attention shifting. But after 4 weeks of relaxation, the changes to the mPFC were reversed. The researchers hypothesized that the pressures of the upcoming high-stakes exam would lead to similar stress-related changes in the brains of the students.

Specifically, the researchers expected to see impairments in the functioning of brain areas involved in attention shifting, such as the dorsolateral prefrontal cortex (PFC). To test this, they had all of the medical students complete an attention-switching task while undergoing an fMRI scan.

Much like the distressed rats, stressed-out students had more difficulty switching their attention between two visual stimuli compared with the control group. The functional-imaging data confirmed that the network including the PFC was engaged during attention shifts; in stressed students, however, there appeared to be a reduction between the connectivity of the PFC and other components of the brain’s attention network.

It appeared as though the stress of preparing for the exam had disrupted connections between neurons in parts of the brain, specifically in regions like the PFC that are associated with modulation of the HPA axis.

Four weeks after completing their exams, the students returned to the lab for another round of scans. This time, the two groups showed no significant differences on either perceived stress or performance on the attention-shifting task. Neuroimaging data revealed that the impairments shown in the formerly stressed-out students’ brain activity also had reversed. After 4 weeks of recovery, their patterns of brain activity were similar to those of the control subjects.

Obviously, 4 weeks of exam prep is not equivalent to the years of stress that many people endure at their jobs. However, this study does suggest that interventions and recovery at the neurological level are possible for people suffering from burnout. œ

Blix, E., Perski, A., Berglund, H., & Savic, I. (2013). Long-term occupational stress is associated with regional reductions in brain tissue volumes. PLOS ONE 8 : e64065. doi:10.1371/journal.pone.0064065

Deligkaris, P., Panagopoulou, E., Montgomery, A. J., & Masoura, E. (2014). Job burnout and cognitive functioning: A systematic review.  Work & Stress , 28 , 107–123. doi:10.1080/02678373.2014.909545

Golkar, A., Johansson, E., Kasahara, M., Osika, W., Perski, A., & Savic, I. (2014). The influence of work-related chronic stress on the regulation of emotion and on functional connectivity in the brain. PLOS ONE 9 : e104550. doi:10.1371/journal.pone.0104550

Gunderman, R. (2014, February 21). For the young doctor about to burn out. The Atlantic . Retrieved from http://www.theatlantic.com/health/archive/2014/02/for-th0e-young-doctor-about-to-burn-out/284005/

Liston, C., McEwen, B. S., & Casey, BJ. (2009). Psychosocial stress reversibly disrupts prefrontal processing and attentional control.  Proceedings of the National Academy of Sciences ,  106 , 912–917. doi:10.1073/pnas.0807041106

Maslach, C. (2003). Job burnout: New directions in research and intervention . Current Directions in Psychological Science, 12 , 189–192. doi:10.1111/1467-8721.01258

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2 , 99–113. doi:10.1002/job.4030020205

Maslach, C., & M. P. Leiter, (Eds.). (2015). It’s time to take action on burnout. Burnout Research ,  2 , iv–v. doi:10.1016/j.burn.2015.05.002

Morgan, C. A., Russell, B., McNeil, J., Maxwell, J., Snyder, P. J., Southwick, S. M., & Pietrzak, R. H. (2011). Baseline burnout symptoms predict visuospatial executive function during survival school training in special operations military personnel.  Journal of the International Neuropsychological Society ,  17 , 494–501. doi:10.1017/S1355617711000221

Oosterholt, B. G., Maes, J. H., Van der Linden, D., Verbraak, M. J., & Kompier, M. A. (2015). Burnout and cortisol: Evidence for a lower cortisol awakening response in both clinical and nonclinical burnout.  Journal of Psychosomatic Research ,  78 , 445–451. doi:10.1016/j.jpsychores.2014.11.003

Savic, I. (2015). Structural changes of the brain in relation to occupational stress.  Cerebral Cortex, 25 , 1554–1564. doi:10.1093/cercor/bht348

Schaufeli, W. B., Leiter, M. P., & Maslach, C. (2009). Burnout: 35 years of research and practice. Career Development International, 14 , 204–220. doi:10.1108/13620430910966406

Toker, S., Melamed, S., Berliner, S., Zeltser, D., & Shapira, I. (2012). Burnout and risk of coronary heart disease: A prospective study of 8838 employees. Psychosomatic Medicine, 74 ,  840–847. doi:10.1097/PSY.0b013e31826c3174

World Health Organization. (2010). Health impact of psychosocial hazards at work: An overview . Geneva, Switzerland: Leka, S., & Jain, A.

Research shows that women stand a better chance of being recognized if they work alone rather than in teams. This would also make them more prone to burnout, since there is no one to share the burden. No wonder this happened to Araiana.

The comprehensive summary of the brain research seems to suggest that burn-out is a variation of PTSD caused by chronic multi-minor traumas instead of major, acute traumas. Agree?

Steven Moffic, M.D.

Chronic Fatigue Syndrome is becoming more and more prevalent in industrialized nations. This illness, which I developed, is not “just being tired”. It affects the hypothalamus, leading to a number of dysfunctions across the entire body system. Helping professionals and others in high-demand positions need to prioritize their own well-being and self-care, including keeping up-to-date on promising interventions such as the Lightening Process developed in Europe.

Expect this type of mental illness to be more and more prevalent across the Western world as human beings are increasingly forced to compete with machines, robots and algorithms. There needs to be a dramatic rethink about the way societies run and people’s expectations of a healthy work/life balance. Sadly I expect that many governments will continue to adopt 19th century solutions to 21st century problems.

Wow, It’s great that more people are becoming aware of and studying burnout, yet, how does this translate into creating the institutional change necessary to avoid workplace burnout? Is there enough evidence to show that when too many parts of a machine break, the machine itself malfunctions? Is burnout socially expansive enough to be said to contribute to society dysfunctions, like increasing apathy?

Please .. how long does it take to recover? Does one need to sleep a lot? I need help recovering.

That depends on so many factors. In my case 3 months stabilised me, but it took many more months before the symptoms of motivational loss, lack of confidence and emotional hyper reactivity went back to close to normal. In those months I adjusted my lifestyle to one that was a lot more healthy i.e. sleeping at least 8 hours EVERY night, eating healthy, meditating regularly, learning to recognise when I was becoming stressed and removing myself from that situation, and psychotherapy (I’d recommend humanistic). Burn-out is more of a very strong message from you body that says get-out-of-this-poisonous-situation. If you get better but just go back into the situation that burned you out in the first place then you haven’t listened to your body. Take care of yourself and trust your gut.

I have heard that burnout causes thigh and gluteal muscles to breakdown. I am presently experiencing pain in these areas. How do I remedy this?

I welcome this study in so many ways because it speaks to the breakdown I have experienced all of my adult life. I have been a CAREGIVERS since my marriage to my husband, 20 years my senior, who was a widower with 2 children, aged 9 & 12 (I was 24) … I later had my own 2 Children, so we became a family of 4. Then my parents came to live with us & I found myself working in a Nursing Home with the elderly… Obviously I took my job &a life too seriously as my health began to suffer…even after retirement I still find myself, at age 77, caring for whoever needs me… By now, after reading this article, I realize, I’m completely BURNED OUT…I have pain everywhere in my body, can’t sleep & have been so dizzy, I use a walker to get around… I cannot make the doctor understand what is going on in my body, but now I know this is a real condition with me and I will be forever grateful for this article having told me that it IS ALL IN MY HEAD AND MY GUT.

Thank you for enlightening me through this article. I believe “Burnout” in general is the result when stress (mental, emotional, physical) exceeds an individuals limitation to that stressor. Not just from working a 70 hour work week. We see it more prevalent in the workplace in today’s day because of the 60-70 hour work week however in my case I was teaching an intense schedule of physical fitness for 5 years, and I am a full-time caregiver to my 3 young children. I crashed similar to the woman in this article back in Feb 2017 and I’m still not feeling quite like myself. My family dr was no help and wanted to treat me for anxiety and depression. It was then that I turned to a naturopathic dr. I’ve been on supplements for the last 14 months despite my Family Dr. recommendations. I’m feeling better now but I’m told it’ll take me between 2-5 years to fully recover. I believe a good naturopath, patience in healing, and being aware of what your stressors are, and removing them can all lead to a road to full recovery.

I want to citating this article. Can anybody help me?

I have two sons both very focused on their studying/work – one has just accomplished a Hons Degree along with a balanced life style. He is fine.

My other son is a researcher in a very controlled science and is working alone and has been for ten years…. without balanced family support – suddenly without anybody in his family realising it his stress levels went up to what must have been impossible levels and he has had what must be a “burnout”. For a while he hated us all having been a loving person. I read that multiple smaller stresses build up and are saved in the brain then along comes a great demand to… eg to finish writing his book and CRASH.

Now I understand thanks to this article.

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About the Author

Alexandra Michel is a science writer at the Association for Psychological Science. She can be contacted at [email protected] .

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Article contents

Burnout in sport and performance.

• Robert C. Eklund Robert C. Eklund University of Stirling
•  and  J.D. Defreese J.D. Defreese University of North Carolina at Chapel Hill
• https://doi.org/10.1093/acrefore/9780190236557.013.165
• Published online: 26 April 2017

Athlete burnout is a cognitive-affective syndrome characterized by perceptions of emotional and physical exhaustion, reduced accomplishment, and devaluation of sport. A variety of theoretical conceptualizations are utilized to understand athlete burnout, including stress-based models, theories of identity, control and commitment, and motivational models. Extant research has highlighted myriad antecedents of athlete burnout including higher levels of psychological stress and amotivation and lower levels of social support and psychological need (i.e., autonomy, competence, relatedness) satisfaction. Continued longitudinal research efforts are necessary to confirm the directionality and magnitude of these associations. Moreover, theoretically focused intervention strategies may provide opportunities for prevention and treatment of burnout symptoms via athlete-focused stress-management and cognitive reframing approaches as well as environment-focused strategies targeting training loads and enhancement of athlete psychological need satisfaction. Moving forward, efforts to integrate research and practice to improve burnout recognition, prevention, and intervention in athlete populations likely necessitate collaboration among researchers and clinicians.

• athlete psychological health
• sport motivation
• perceived stress

Introduction

Burnout among athletes as a consequence of the stress of highly competitive sport became a concern following the emergence of commentaries on troubling chronic experiential states experienced by some professionals in stressful alternative health care (e.g., Freudenberger, 1974 , 1975 ) and human service settings (e.g., Maslach, 1982 ). Freudenberger’s observations on a phenomenon involving physical and mental deterioration and workplace ineffectiveness as a consequence of excessive demands among alternative health care professionals are typically regarded as formally ushering the term “burnout” into the psychosocial lexicon (Eklund & Cresswell, 2007 ). Maslach ( 1982 ) observed a similar phenomenon in studying human service workers. Her development of the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981 , 1986 ) to study the phenomenon effectively served to conceptually formalize burnout as an experiential syndrome involving symptoms of sustained feelings of emotional exhaustion, depersonalization (negative attitudes and feelings toward the recipients of the service), and inadequate personal accomplishment (a sense of low accomplishment and professional inadequacy). Following the emergence of these insights and developments in work settings, “burnout” in sport quickly became an amorphous catch-all explanation for an array of troubling phenomena, including the negative, amotivated, and exhausted states sometimes suffered by athletes as well as implicated problems with injury, sport withdrawal, and/or personal dysfunction. Efforts to conceptualize and understand athlete burnout started appearing in the sport science literature soon thereafter (e.g., Cohn, 1990 ; Feigley, 1984 ; Gould, 1993 ; Henschen, 1990 ; Rowland, 1986 ; Schmidt & Stein, 1991 ; Smith, 1986 ; Yukelson, 1990 ).

While the notion of burnout held considerable appeal for sport scientists, reservations existed about the relevance and applicability of Maslach and Jackson’s ( 1981 , 1986 ) burnout syndrome to athletes (e.g., Feigley, 1984 ; Garden, 1987 ). The stresses and circumstances of athletes’ involvement in sport are much different from those of professionals involved in health and human service settings, so it seemed entirely reasonable to question “the extent to which the nature, causes and consequences are unique and to what extent they are shared by those who suffer burnout in other domains of activity” (Smith, 1986 , p. 44). Nonetheless, variation in the nature of ongoing stressful demands does not inherently require that the associated experiential consequences also differ in their aversive nature. Evidence across a variety of workplace settings has indicated that there is commonality in the experience of burnout in response to chronic situational exposure to psychosocial stress, despite variation in the specific stressors implicated across workplace settings (Schaufeli & Enzmann, 1998 ). Evidence from studies with athletes involved in serious competitive sport have also supported Schaufeli and Enzmann’s conclusions about cross-domain (i.e., sport versus work) commonality in the experience of burnout as a response to chronic exposure to psychosocial stress (Eklund & Cresswell, 2007 ; Goodger, Gorely, Lavallee, & Harwood, 2007 ).

The athlete burnout syndrome as conceptualized by Raedeke ( 1997 ), Raedeke and Smith ( 2001 ) is characterized by the enduring experience of (1) emotional and physical exhaustion, (2) sport devaluation, and (3) reduced accomplishment. Although modified to be of particular relevance to sport, this sport-specific conceptualization of the syndrome is consistent with the syndrome posited by Maslach and Jackson ( 1981 , 1986 ). Specifically, the general notion of a sense of inadequate or reduced personal accomplishment being symptomatic of burnout mapped over directly in Raedeke’s conceptualization. Maslach and Jackson’s ( 1981 , 1986 ) emotional exhaustion syndrome facet was extended to include chronic physical exhaustion. This modification was consistent with the broadening of the exhaustion construct in the third edition of the MBI manual with the introduction of the MBI General Survey (Maslach, Jackson, & Leiter, 1996 ). The original depersonalization syndrome facet was argued to have little sport-specific relevance because client services do not feature in athletes’ experiences per se, so it was replaced with a facet relating to sport devaluation (a cynical and diminished appraisal of the benefits of sport involvement by the athlete). This change was also consistent with the re-conceptualization of depersonalization in the general workplace literature as a particular manifestation of the cynicism that occurs in burnout (e.g., Maslach et al., 1996 ; Maslach, Schaufeli, & Leiter, 2001 ). Overall, the emergence and subsequent broad acceptance of this syndrome conceptualization of athlete burnout resulted in commentaries that took on more conceptual coherence. Empirical investigations of this commonly accepted athlete burnout conceptualization also served to advance theoretical understanding of the problematic condition.

The emergence of Raedeke’s ( 1997 ), Raedeke and Smith ( 2001 ) syndrome conceptualization was also particularly important because, before that time, discussions of athlete burnout were not necessarily all focused on the same construct. The commentaries instead spanned a variety of distinct, if interrelated, constructs, including reference to depressed mood states, amotivation, maladaptive psychophysiological responses to training, sport dropout, and so on (Eklund & Cresswell, 2007 ). The “everybody knows what it is” problem (Marsh, 1998 , p. xvi) was evident in the variety of idiomatic and amorphous conceptualizations being discussed because the commentaries were often grounded in anecdotal accounts provided by coaches, sport scientists, and even athletes themselves (Dale & Weinberg, 1990 ; Rotella, Hanson, & Coop, 1991 ). The net effect was that early research and theoretical development efforts were focused on an array of constructs all sharing the label of “athlete burnout” rather than a single common experience.

The noticeably different conceptualizations of athlete burnout employed by Silva ( 1990 ) and Coakley ( 1992 ) are illustrative of the problem identified in the preceding paragraph. Silva conceptualized athlete burnout as the ultimate phase in a maladaptive response to overtraining. The burnout phase, though sharing some commonalities with the burnout syndrome conceptualization, was posited to become manifest when “[t]he organism’s ability to deal with the psychophysiological imposition of stress is depleted, and the response system is exhausted” (p. 11). Silva’s ( 1990 ) perspective effectively conflates the burnout syndrome with the overtraining (or staleness) syndrome (Eklund & Cresswell, 2007 ). Some commonalities are evident across the two chronic conditions (e.g., exhaustion, mood disturbances, concerns about performance adequacy), but they should be regarded as distinct conditions requiring nonidentical intervention strategies (Raglin, 1993 ). At its core, the overtraining syndrome is a chronic condition involving systemic (e.g., neurological, endocrinological, and immunological) maladaptive responses to excessive overreach training (Kreher & Schwartz, 2012 ). The athlete burnout syndrome, however, results from chronic exposure to psychosocial stress and, importantly, can become manifest entirely in the absence of excessive overreach training (Eklund & Cresswell, 2007 ). Coakley’s ( 1992 ) conceptualization of athlete burnout, however, is considerably different. He regarded athlete burnout as being withdrawal (i.e., dropout) from committed, successful involvement in highly competitive youth sport to escape its controlling and aversive socioenvironmental constraints. His perspective stands in stark contrast with other extant athlete burnout conceptualizations (e.g., Raedeke, 1997 ; Silva, 1990 ; Smith, 1986 ) wherein withdrawal from sport is viewed not as burnout in and of itself but rather as one potential, but not requisite, consequence of the burnout experience.

Given the existence of the variety of different conceptualizations employed in early athlete burnout research, some entangled with other related but distinct conditions (e.g., depression, overtraining syndrome, dropout), careful consideration is required in interpreting that literature relative to more contemporary syndrome-based efforts. Despite the conceptual challenges presented in some of the historical efforts, they were important to the field. They incited interest in the empirical investigation of burnout in sport and ultimately resulted in greater fidelity in construct conceptualization as well as the introduction of well-grounded theoretical explanations of the aversive experiential state (Eklund & Cresswell, 2007 ).

An early milestone in research on athlete burnout can be found in the International Tennis Federation’s implementation of rule changes and provision of educational recommendations to deal with the problem in the 1980s (Hume, 1985 ). Subsequent funding of a research project on athlete burnout by the United States Tennis Association Sport Science Division (e.g., Gould, Tuffey, Udry, & Loehr, 1996 , 1997 ; Gould, Udry, Tuffey, & Loehr, 1996 ) served to catalyze the interest of sport psychology researchers in the topic. The absence of a conceptually and psychometrically sound measure of athlete burnout, however, presented an initial obstacle to research. The arrival of the Athlete Burnout Questionnaire (ABQ; Raedeke, 1997 ; Raedeke & Smith, 2001 ) resolved that problem, and subsequent research on the topic has burgeoned in quantity, and conceptual and methodological sophistication.

Key Burnout Antecedents and Supporting Theories/Models

Ultimately, early anecdotal accounts and attempts to formulate theories on athlete burnout led to a core set of historical explanations for the sport-based phenomenon. Three early conceptualizations were especially influential; they specified that burnout was the result of (1) chronic exposure to psychological stress and maladaptive coping processes (Smith, 1986 ), (2) a maladaptive pattern of sport commitment (Raedeke, 1997 ), or (3) the autonomy-usurping constraints of intense involvement in highly competitive youth sport on young athletes’ identities and control beliefs (Coakley, 1992 ). Ultimately, all three conceptualizations have been useful in developing broad understandings of athlete burnout and key antecedents, despite the lack of definitional uniformity across instances. They continue to have relevance for investigative design and interpretation of burnout research. Consequently, we briefly review each conceptual perspective before outlining some general tenets of self-determination theory (Deci & Ryan, 1985 ; Ryan & Deci, 2000a , 2000b ). Self-determination theory has subsequently become an influential theoretical perspective guiding athlete burnout research.

Smith ( 1986 ) provided perhaps the earliest formal theorizing on athlete burnout as a psychosocial construct in the sport science literature. His conceptualization of burnout related to the “psychological, emotional, and at times a physical withdrawal from a formerly pursued and enjoyable activity” (p. 37). It relied on the work of several theoretical perspectives from psychology, including social exchange theory (Thibaut & Kelley, 1959 ) and Lazarus’s ( 1966 , 1982 ) contentions on emotion and the stress and coping process. In Smith’s view, athlete burnout was a result of chronic sport-related appraisals of stress that were not effectively mitigated by coping efforts. A variety of cross-sectional research studies have supported links between burnout and perceived stress and deficits in coping resources (e.g., Raedeke & Smith, 2001 ; 2004 ). More recently, Schellenberg, Gaudreau, and Crocker ( 2013 ) provided longitudinal evidence in a study of passionate involvement in sport supporting earlier cross-sectional findings on links between coping and athlete burnout. Specifically, in their study of 421 volleyball athletes, changes in athlete burnout were positively predicted by obsessive passion via its mediated positive association with disengagement-oriented coping behaviors. Overall, as supported in a systematic review of literature (Goodger et al., 2007 ), the psychological stress and coping model represents a useful, if somewhat rudimentary, conceptual means to understanding athlete burnout. Research conducted from this perspective indicates that perceived stress tends to exacerbate the possibility of an athlete experiencing burnout as do athlete deficits or mismatches in coping skills and resources.

The second historical burnout conceptualization, offered by Coakley ( 1992 ), involved a focus on the sociological factors that may contribute to athlete burnout. Based on data from qualitative interviews with adolescent athletes, Coakley ( 1992 ) concluded that burnout, conceptualized as a particular type of withdrawal from sport, was the result of environmental constraints rather than the individual’s responses to stress per se. Specifically, Coakley posited that this particular type of withdrawal from sport resulted from the development of a unidimensional sport identity and the individual athlete’s perceived lack of control over his or her sport participation. This perspective has received very limited empirical support; the exception is the partial support found in one study of competitive swimmers (Black & Smith, 2007 ). Despite limited empirical support, this conceptualization does bring important attention to the idea that, beyond individual perceptions of stress or commitment, organizational (or team) factors within intensely competitive youth sport may contribute to athlete burnout (Coakley, 2009 ). Certainly, this conceptualization has focused additional, necessary attention on the social structure and demands of sporting environments in which athletes participate, rather than solely on individual differences in athlete appraisals of stress as the major contributor to burnout.

The third early perspective posited that burnout symptoms could arise from a specific constellation of athletes’ perceptions of their commitment to sport. Building on the broader sport commitment framework proposed by Schmidt and Stein ( 1991 ), Raedeke ( 1997 ) conceptualized burnout as a potential result of entrapped commitment to sport (as opposed to attraction-based commitment, which has benign or even salutatory effects). Specifically, Raedeke postulated that this maladaptive sport commitment pattern (characterized by a high level of perceived costs, investments, and social constraints along with few perceived benefits or alternatives), if sustained, would result in the athlete’s elevated perceptions of burnout. Support for this conceptualization was found using cluster analytic procedures, with data obtained from a sample of adolescent swimmers (Raedeke, 1997 ). Specifically, the cluster of swimmers endorsing this entrapped pattern of commitment stress reported the highest levels of burnout symptoms (exhaustion, devaluation, reduced accomplishment). Ultimately, this commitment theory perspective on athlete burnout has received some theoretical support and continues to be used to design and interpret athlete burnout research.

Finally, over the last decade or so, researchers have increasingly turned to self-determination theory (SDT; Deci & Ryan, 1985 ; Ryan & Deci, 2000a , 2000b ), a prominent theory of human motivation, as an explanation to advance understanding of athlete burnout. This theory has proven to be exceptionally useful and revealing in those efforts. In SDT, Deci and Ryan contend that satisfaction of basic psychological needs results in optimal human functioning, social development and personal well-being, while the thwarting of psychological needs has the less salubrious results of diminished personal and social functioning and states of ill-being. The psychological needs enumerated in SDT include the needs for autonomy (i.e., to experience behavioral volition), competence (i.e., to perceive oneself as behaviorally effective), and relatedness (to feel socially interconnected with valued others). Satisfaction of these needs is regarded as being universally essential for human health and well-being.

In SDT, motivation is considered relative to the broad categories of autonomous and controlled motivation as well as relative to the more specific motivational regulations underlying behavioral enactments (i.e., intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, amotivation). Autonomous motivation includes self-determined behavioral imperatives to satisfy one’s fundamental psychological needs (i.e., intrinsic motivation) and extrinsic but internalized motivational imperatives that can also satisfy these needs in some degree because they are consistent with one’s identity (i.e., integrated regulation) and/or personal objectives (i.e., identified regulation). Controlled motivation is more externally controlled (and thus less self-determined) and includes behaviors governed by external punishment and reward contingencies (i.e., external regulation) and behaviors resulting from feelings of shame, guilt or pride (i.e., introjected regulation). Finally, amotivation, arguably the motivational signature of athlete burnout (Eklund & Cresswell, 2007 ), involves behavior without intent to act resulting from not feeling competent, not believing that effort will result in desired outcomes, or not inherently valuing an activity (Ryan & Deci, 2000b ).

Evidence supports SDT claims that autonomous behaviors supported by self-authored, or self-determined motivational regulation, are more adaptive, whereas behaviors governed by controlled motivational regulations and amotivation are less adaptive for motivational persistence, psychological health, and well-being (Ryan & Deci, 2000a , 2000b ). With regard to athlete burnout, individuals whose experiences fail to satisfy or thwart the aforementioned psychological needs would be expected to exhibit less self-determined forms of sport motivation and, ultimately, higher levels of athlete burnout. Overall, the efficacy of self-determination theory in facilitating researcher efforts and understanding of athlete burnout has been supported in Li, Wang, Pyun, and Kee’s ( 2013 ) systematic review of literature in this area.

Review of Current Knowledge Base on Burnout in Sport

Collectively, research guided by the aforementioned theories and models has advanced our understanding of the occurrence and consequences of the athlete burnout syndrome while also serving as a useful guide to informing applied practice in sport (DeFreese, Smith, & Raedeke, 2015 ). This review of the burnout literature is intended to be representative of the knowledge base and informative as to future work, though it is not absolutely comprehensive. This section describes a pair of larger-scale research projects funded by the U.S. Tennis Association (USTA) and the New Zealand Rugby Union (NZRU) and also highlights important projects that are representative of the key conceptual outcomes of the contemporary burnout knowledge base.

Initial Funded Burnout Projects

The USTA provided support for one of the first funded projects on athlete burnout. The reports emanating from the mixed-methods research endeavor were informative (e.g., Gould, Udry et al., 1996 ; Gould, Tuffey et al., 1996 , 1997 ) and, not surprisingly given the high-profile nature of the project, have been influential. The investigation was grounded in Gould’s ( 1996 ) conceptualization of athlete burnout as a motivational response to sport participation. He maintained that the commonly reported decreases in sport motivation observed among athletes reported as being “burned out” were the result of their prior highly motivated sport engagement involving chronic exposure to stress in their sport involvements. In observing that the stress encountered by athletes could be psychological and/or the result of training stress, Gould argued that burnout could be experienced either psychologically or physically. Some support for his position was found among the elite adolescent tennis players taking part in the USTA study (Gould, Udry et al., 1996 ; Gould, Tuffey et al., 1996 , 1997 ). Specifically, athlete burnout was associated with less adaptive forms of motivation (i.e., amotivation), lower self-reported use of coping skills, high levels of perfectionism, and social pressures from parents or coaches. This research was integral to the early understanding of athletes’ burnout experiences and served as a guide for much of the subsequent research conducted in the area. In sum, the USTA study was important even if its eclectic conceptual grounding and use of an early tenuous measure of athlete burnout present some challenges for interpretation.

A subsequent series of studies funded by the New Zealand Rugby Union (NZRU) also contributed to the knowledge base on athlete burnout on conceptual, measurement, and methodological accounts. As a starting point, interviews with 15 rugby athletes endorsing elevated burnout symptoms about their experiences with burnout supported the relevance of the burnout syndrome and highlighted several key burnout antecedents in the rugby environment, including competitive transitions, heavy playing and training demands, and social pressures to comply with demands despite physical or mental fatigue (Cresswell & Eklund, 2006c ). A multitrait–multimethod assessment of athlete burnout measurement provided important evidence indicating that psychometrically valid and reliable data could be obtained with the ABQ and that burnout in elite rugby athletes was psychometrically related but nonetheless distinct from depression (Cresswell & Eklund, 2006b ). Across the series of studies, consistent evidence was obtained indicating that athlete burnout was associated with less self-determined forms of motivation among professional and top amateur rugby players (Cresswell & Eklund, 2004 , 2005b , 2005c ).

The NZRU investigation also involved some of the earliest longitudinal research efforts, two of which were quantitative and one was qualitative. In the first instance, a 30-week “rugby year” monitoring study (Cresswell & Eklund, 2006a ) was conducted to assess burnout experiences across time for athletes playing in multiple tournaments representing different teams (e.g., club, provincial, national) at different points in time. Data were collected from professional players ( n = 109) at three time points (i.e., at the end of precompetitive training, approximately 10 weeks later during the season, and finally at approximately 30 weeks—during the final weeks of regular games). In hierarchical linear modeling (HLM) analyses, statistically significant variation was observed over time in burnout dimensions of reduced accomplishment and exhaustion but, contrary to expectations, in a nonlinear fashion. Players reported an increase in reduced accomplishment by the second time point, but further increases were not observed in the closing weeks of the rugby year. Changes on the exhaustion dimension varied across time by position (i.e., backfield and forward players), with the backs reporting a sharper decrease in exhaustion at midseason measurement than forwards and a subsequent sharper increase at the end of the competitive year.

In a separate study assessing both burnout and SDT motivational constructs, changes in burnout were again observed among athletes over the course of a 12-week tournament (Cresswell & Eklund, 2005a ). Data in this tournament within the “rugby year” were also collected at three time points (pre-tournament, mid-tournament, and end of tournament) from professional rugby players ( n = 102). Significant variation over time in burnout was only observed in the reduced accomplishment dimension, and a significant team by time interaction suggested that the variation was due to more than just game outcomes. As expected, amotivation was positively associated with end of tournament burnout, and self-determined motivation was inversely associated with burnout perceptions at this later period. A number of other pragmatic factors of interest were also associated with the key characteristics of burnout across time in the HLM analyses, including win/loss ratio, injury, starting status, playing position, experience, and team membership.

In the third longitudinal qualitative study (Cresswell & Eklund, 2007 ), interview data were obtained from professional players ( n = 9) and members of team management ( n = 3), and again at three time points (pre-season, mid-season and end of season) over a 12-month period. These data revealed that there was a dynamic element to athletes’ experiences of burnout over the course of the year that included periods of positive and negative change over the time frame. These data also suggested that elevations in perceptions of burnout were attributed to matters such as playing and training demands, competitive transitions, injury, and pressures from coaches/administrators, as well as from the media.

As with the USTA-funded project, the studies conducted in the NZRU project advanced the extant literature on athlete burnout on both conceptual and empirical grounds. Unlike the USTA project, however, the NZRU studies occurred at a time when other active programs of research were also emerging within the field—which is to say that research inquiry on athlete burnout was on the uptick at that time. Perhaps most notably, Lemyre and his colleagues (e.g., Lemyre, Hall, & Roberts, 2008 ; Lemyre, Treasure, & Roberts, 2006 ; Lemyre, Roberts, & Stray-Gundersen, 2007 ), as well as Lonsdale and his colleagues (e.g., Lonsdale, Hodge, & Rose, 2006 , 2009 ; Hodge, Lonsdale, & Ng, 2008 ) were also conducting important studies on athlete burnout, also typically grounded in SDT, at a time overlapping with the NZRU studies. In short, subsequent to the USTA project and the arrival of the ABQ, athlete burnout has emerged as a topic of focal interest within sport psychology wherein the sophistication and number of articles published has noticeably increased year on year.

Theoretical Elaboration and Extension in Athlete Burnout Research

The bulk of the motivationally grounded athlete burnout research in the last decade or so has often been grounded in SDT although other theories (e.g., achievement goal theory) that also make differentiations in motivational qualities have also been employed. Sport psychology researchers have found considerable intuitive appeal in the notions that the quality of athlete motivation or athlete unsatisfied fundamental psychological needs might cause and/or mediate the emergence of aversive sport-based involvement experiences. Overall, theory testing investigations in the area, including cross-sectional and longitudinal designs, have been informative for developing understanding of processes involved in burnout in sport settings.

As a starting point, Lemyre and his colleagues (e.g., Lemyre et al., 2006 , 2007 , 2008 ) have conducted prospective design investigations that have been revealing in supporting a SDT explanation of the burnout experience among athletes. They examined the possibility that motivational shifts along a continuum of self-determination could predict athlete burnout symptom development over time among collegiate swimmers ( n = 44). Variability in self-determined motivation over a season was indeed found to predict swimmers’ end-of-season burnout symptoms, with shifts toward less self-determined motivational regulations being associated with elevations in athlete burnout. In a related prospective investigation, Lemyre et al. ( 2007 ) examined the possibility that beginning-of-season motivation, as operationalized using a self-determination motivational continuum index, could predict end-of-season burnout in elite and junior elite winter sport athletes ( n = 141). As expected, end-of-season burnout was significantly predicted by pre-season scores on the self-determined motivation continuum. Interestingly, the prediction of burnout was enhanced when symptoms of overtraining were also included in the analytic model. This pair of studies provided substantial evidence supporting the utility of self-determination theory for understanding athlete burnout. Specifically, athletes experiencing more self-determined forms of motivation endorsed lower burnout scores at the end of the training period assessed in each instance. In a related third study grounded in achievement goal theory rather than SDT, Lemyre, Hall, and Roberts ( 2008 ) reported athlete burnout to be positively associated with athlete-endorsed ego/outcome motivational climates (characterized by an emphasis on winning and social comparison) and negatively associated with task/mastery climates (characterized by an emphasis on individual effort and improvement). This pattern of findings was subsequently replicated and extended in research focused specifically on the motivational climate created by teammate peers (Smith, Gustafsson, & Hassmén, 2010 ) without reference to coaches, parents, or administrators.

Self-determined motivation has also been examined as a mediator of relationships with athlete burnout (e.g., Appleton & Hill, 2012 ; Curran, Appleton, Hill, & Hall, 2011 ; Jowett, Hill, Hall, & Curran, 2013 ) or, alternatively, as an adaptive psychological outcome in the study of athlete burnout (e.g., DeFreese & Smith, 2013b ). Curran et al. ( 2011 ), for example, found support for the hypothesis that the relationship between harmonious passion and burnout would be mediated by self-determined motivation in cross-sectional data obtained from a sample of male elite junior soccer players ( n = 149). In contrast, DeFreese and Smith ( 2013b ) found teammate social support satisfaction and perceived availability of support to be both positively associated with self-determined motivation and negatively associated with burnout in cross-sectional data obtained from collegiate American football athletes ( n = 235).

Finally, Lonsdale and Hodge ( 2011 ) considered the temporal question on the causal sequencing of relationships between burnout and self-determined motivation and showed that that lower levels of self-determined motivation preceded the development of burnout. Though not settling the matter of causal sequencing definitively, their findings did provide support for a self-determination theory grounded explanation of athlete burnout.

Relative to the basic psychological needs subtheory of SDT, researchers have also examined satisfaction of the fundamental psychological needs of autonomy, competence, and relatedness and their association with burnout in athlete populations. Research on elite rugby players found that players classified as “high-burnouts” reported lower perceptions of need fulfillment compared to “low burnouts” (Hodge, Lonsdale, & Ng, 2008 ). Interestingly, however, research has also suggested that simultaneous satisfaction of psychological needs is associated with lower levels of athlete burnout than satisfaction of any psychological need individually (Perreault, Gaudreau, Lapointe, & Lacroix, 2007 ). Finally, an inverse relationship between psychological need satisfaction and athlete burnout has been reported in data from elite Canadian athletes ( n = 201) showcasing self-determined motivation as a potential mediator of the relationship (Lonsdale, Hodge, & Rose, 2009 ). In sum, self-determination theory has received considerable support in the extant literature as an effective means to understand athlete motivation and psychological health outcomes, including burnout. That said, motivation may be understood through a variety of other theoretical conceptualizations (e.g., achievement goal theory, attribution theory). Acordingly, self-determination theory is not the only potentially useful motivational framework for the conceptual grounding of athlete burnout research.

Coaching and Athlete Burnout

Burnout researchers have also conducted studies examining the potential influence of sport-based social agents on athlete burnout. Of note, the impact of significant others (e.g., coaches) was highlighted in both the USTA and NZRU research programs. Thus, coaches are key members of the sport-based training and competition environment, and their influence on athletes is nontrivial. The idea that coaching styles and behaviors may contribute to the experiences of burnout among athletes seems logical, perhaps especially given earlier evidence that the burnout being experienced by coaches may elevate the risk of burnout among their athletes (Price & Weiss, 2000 ; Vealey, Armstrong, Comar, & Greenleaf, 1998 ). Recent theoretically grounded studies of coaching styles and behaviors relative to athlete burnout have revealed that coach interactions with athletes are worthy of consideration in the matter; perhaps even as a potential focus of burnout intervention efforts (e.g., Barcza-Renner, Eklund, Morin, & Habeeb, 2016 ; DeFreese et al., 2015 ; González, García-Merita, Castillo, & Balaguer, 2015 ).

As a first example, the González et al. ( 2015 ) longitudinal investigation implicates the leadership style provided by coaches in working with their athletes as a potential antecedent of athlete burnout. Specifically, González et al. ( 2015 ) reported the results of a two-season SDT-grounded prospective investigation of associations between athlete-perceived coaching styles and athlete outcomes of well- and ill-being (respectively, self-esteem and burnout). Among the 360 male youth soccer athletes sampled, athlete perceptions of an autonomy-supportive coaching style were found to be positively associated with self-esteem development across seasons and negatively associated with the development of burnout via a positive association with psychological need satisfaction and a negative association with psychological need thwarting. Athlete perceptions of a controlling coaching style, however, were negatively associated with development of self-esteem across seasons and positively associated with the development of burnout via negative association with psychological need satisfaction and positive association with psychological need thwarting. Ultimately, longitudinal assessment of the association of athlete perceptions of coaching behaviors with athlete burnout perceptions supports the idea that coaching styles may have a developmental impact on athlete psychological health and well-being. This position merits continued examination across athlete ages and competition levels.

Barcza-Renner et al. ( 2016 ) extended research in this area by examining the potential mediating effects of athlete perfectionism and motivation on the relationship between controlling coaching behaviors (as opposed to the more general controlling coaching style) and athlete burnout. Division I NCAA collegiate swimmers ( n = 487) provided cross-sectional data for analysis within three weeks of their conference championship meet. Athlete perceptions of controlling coaching behavior were predictive of athletes’ socially prescribed and self-oriented perfectionism and their motivation (i.e., autonomous, amotivation). Specifically, self-oriented perfectionism was positively associated with autonomous motivation and negatively associated with amotivation. In contrast, socially prescribed perfectionism was negatively associated with autonomous motivation and positively associated with controlled motivation and amotivation. Autonomous motivation and amotivation, in turn, predicted athlete burnout in expected directions. Support for the potential mediating effects was observed in modeling results, with significant indirect effects across model pathways. Overall, these results also support self-determination theory contentions that the social context of engagement has motivational implications for the health and well-being of involved actors in sport.

An organizational psychology perspective that may be useful in the continued examination of athlete perceptions of social actors, including coaches, on their sport experience can be found in Leiter and Maslach’s ( 2004 ) areas of worklife conceptual framework. As adapted to sport by DeFreese et al. ( 2015 ), this framework is grounded in the notion that athletes’ satisfaction with perceptions of the congruence or “fit” of their interests/values as an athlete and the interests/values of actors in their sport organizations (i.e., coaches, administrators) have implications for their psychological outcomes. Incongruences were hypothesized to be associated with elevations in athlete burnout; whereas, good athlete-sport organization “fits” were expected to be associated with more adaptive psychological outcomes. Examination of data from a sample of collegiate American football athletes ( n = 235) provided support for this conceptual perspective (DeFreese & Smith, 2013a ). Regardless of the framework used, however, research to date supports the importance of coaches to their athletes’ sport-based burnout experiences. Overall, the athletes’ relationships with their coaches and other sport organizational social agents can shape their perceptions of sport involvement and burnout.

Ideographically Oriented Research on Burnout

The case study has been another important method for understanding individual differences in athlete burnout and the development of its symptoms. Gustafsson, Kenttä, Hassmén, Lundqvist, and Durand-Bush ( 2007 ), for example, conducted retrospective interviews with elite Scandinavian endurance athletes ( n = 3). All athletes exhibited burnout syndrome dimensions as conceptualized by Raedeke ( 1997 ), Raedeke and Smith ( 2001 ), as well as the key conceptual burnout antecedents identified in the extant literature, including strong athletic identities and decreases in sport motivation associated with maladaptive sport commitment patterns over time. Moreover, all individuals in the study described their burnout symptoms to be negatively associated with their overall mood and athletic performance. Nonetheless, individualized contributors to burnout were evident in each case as well (i.e., stress levels, anxiety, injury). These findings were replicated and extended in a related interview study involving 12 Swedish athletes with elevated ABQ scores (Gustafsson, Hassmén, Kenttä, & Johansson, 2008 ). More specifically, this second study provided additional support for the conceptually linked burnout antecedents identified in this group’s previous work as well as highlighted the description of “total overload” from sport and life demands such as school. In sum, research on individual burnout cases has been integral to understanding symptom development in “burned-out” athletes, while largely supporting the results of nomothetic analyses of data obtained from larger athlete cohorts endorsing varying levels of burnout symptoms.

Selected Longitudinal Burnout Research Efforts

Longitudinal research studies on athlete burnout continue to grow in both number and impact on understanding of the phenomenon. Accordingly, recent research efforts have focused on longitudinal monitoring of burnout and its antecedents of perfectionism, social perceptions, and gender. These studies represent a positive trend toward further understanding of burnout development. Accordingly, we have selected recent studies that have had significant impact on the understanding of athlete burnout development (e.g., DeFreese & Smith, 2014 ; Isoard-Gautheur, Guillet-Descas, Gaudreau, & Chanal, 2015 ; Madigan, Stoeber, & Passfield, 2015 , in press).

First, Madigan, Stoeber and Passfield ( 2015 ) examined perfectionism and burnout among junior sport academy athletes over three months of active training. Results of this two time-point assessment of advanced junior athletes ( n = 101) indicated that perfectionistic concerns scores predicted heightened burnout levels over the study window, whereas perfectionistic striving scores predicted decreases in burnout over the same time period. These intriguing and suggestive findings on the potential contributions of different types of perfectionism to burnout development were limited by the two time-point investigative design. This research group’s subsequent, more sophisticated, three time-point analyses of data obtained from junior athletes ( n = 141) attending sporting academies, however, further clarified the pattern of associations among these variables. Specifically, Madigan, Stoeber, & Passfield, ( 2016 ) found support for the perfectionism-burnout link to be mediated by athlete motivation. Within a three time-point multilevel structural equation model, autonomous motivation was found to mediate the negative relationship between perfectionistic strivings and burnout at both the between- and within-person levels. Controlled motivation, however, was found to only mediate the positive relationship between perfectionistic concerns and burnout at the between-person level. This pair of multipanel studies further highlights the relevance of understanding the potentially paradoxical effects of the different types of perfectionism on athlete burnout understanding as well as the potentially mediating effects of different qualities of sport motivation. This promising area merits continued examination in future athlete burnout research efforts.

Second, DeFreese and Smith ( 2014 ) examined the impact of social support and negative social interactions perceptions on athlete burnout and well-being (as indicated by life satisfaction) over four time points in a competitive season among 465 collegiate athletes. After accounting for commonly identified antecedents of athlete burnout (i.e., perceived stress, sport motivation, trait negative affect, trait optimism) across time, social support and negative social interactions were associated (respectively, negatively and positively) with athlete burnout across the competitive season. In contrast, the prediction of athlete life satisfaction across the competitive season by social support and negative social interactions exhibited relationships in the opposite directions to those observed in predicting athlete burnout (i.e., respectively positive and negative in association). Altogether, this study highlighted the importance of both the positive and negative athlete perceptions of the social environment to burnout and has serious implications for continued longitudinal burnout monitoring and prevention efforts.

Finally, Isoard-Gautheur, Guillet-Descas, Gaudreau, and Chanal’s ( 2015 ) recent report on the development of burnout among elite adolescent handball athletes at a national athlete training center in France sheds light on potential gender differences that might be implicated in the process. Their five-wave multiyear study of 895 male and female athletes (aged 13–18 years at initial data collection) highlighted significant decreases in the reduced accomplishment burnout dimension over time, with the effect being most pronounced for girls. Moreover, significantly different rates of change in the exhaustion dimension were observed in interactions with the sport devaluation dimension, with, interestingly, exhaustion being attenuated at times of higher levels of sport devaluation. Overall, however, sport devaluation tended to increase over the five-year period, and more so among girls than for boys. Ultimately, changes in the burnout syndrome facets of emotional and physical exhaustion (i.e., remained relatively stable across time) and reduced accomplishment (i.e., decreased across time) developed in a way that was developmentally consistent with athlete well-being across adolescence and relative to present-day gender differences in sport importance. This study provides a particularly good example of the integration of interests in simultaneously acquiring research and clinical knowledge through the developmental monitoring of burnout symptoms among athletes in elite performance programs. The consideration of other factors (e.g., training schedule, competitive level, perfectionistic tendencies) that may be reasonably expected to influence the experience of athlete burnout (as occurred with gender in this study) is also warranted in future, similar investigations. Certainly, the accumulation of knowledge on developmental trends and influences on burnout development when combined with well-tested explanatory theory offers the prospect of effective alternatives for clinical interventions designed to prevent or ameliorate the development of burnout symptom in the future.

Future Research Directions

One inherent problem with the discussion of future research directions on athlete burnout is that there can seem to be so many potential research areas that it can be difficult to decide where to start. This article presents some guidance on starting points for future research. The future burnout research directions identified are not meant to be exhaustive but, rather, to provide grist for a fruitful conversation among sport scientists and clinicians in designing studies to add to the knowledge base on burnout while also informing practice. The few future research directions on athlete burnout provided subsequently merit specific consideration at least on that account.

The adequacy of research and clinical practice rests substantially on the availability of measures that are suitable, reliable, and well validated. As a consequence, our first recommendation on future research directions is relative to athlete burnout measurement. The emergence of the ABQ, the Athlete Burnout Questionnaire, the most commonly used measure of the construct since its initial development in 1997 , opened new horizons in athlete burnout research. Despite the resulting advances in athlete burnout research, recent discussion has pointed to the need to further improve the measurement of athlete burnout. Researchers should proceed cautiously on this front because measurement development should not be an end in itself; rather, it should be a matter that occurs in service of advancements in research or clinical purpose. Throughout its extensive in athlete populations varying on a variety of demographic dimensions (e.g., age, gender, sport, competitive level), the ABQ has consistently exhibited acceptable levels of reliability and validity (Raedeke & Smith, 2009 ).

Nonetheless, certainly no measure is perfect, and the ABQ is not an exception to that truism. Nonetheless, much work remains to be done in exploring ABQ scores relative to matters such as nomothetic and ideographic cut-points for elevated risk of consequences associated with burnout, its utility for monitoring the effectiveness of clinical or program based interventions, or matters relating to its suitability for use across a variety of situations and populations. Specifically, to ensure reliability in this key target population, which is most often examined through qualitative methods, continued measurement development is necessary in populations of “burned-out” athletes (i.e., those endorsing high levels of burnout symptoms). Such work represents a future research direction, with implications for both ongoing research and practice efforts relative to athlete burnout.

Measurement development may be useful for purposes beyond those initially envisaged for the ABQ. All the same, a well-informed sense of ABQ limitations, as well as current and future measurement needs, should be primary considerations if developmental efforts are to be fruitful. Thus, continued efforts to examine the reliability and validity of the ABQ are needed so that any move to refine or replace it is informed by identified measurement needs for research and/or clinical practice rather than simply being a quest to have a different measure. Continued research to optimize measurement of athlete burnout is needed, but it is also important to be mindful of the issues of conceptual confusion which have historically plagued understanding of this psychological construct. One area relative to ABQ advancement that has already been made apparent—a condensed version minimizing response burden (preferably providing data with similar reliability and validity properties)—could be very useful to researchers. Subject burden can be a compliance issue in longitudinal monitoring studies, particularly in studies that assess other psychological health and well-being variables. Hence, the availability of a reliable and valid short version of the ABQ is an avenue of fairly immediate interest.

Research efforts in organizational psychology have examined whether a temporal sequencing exists in the developmental progression of burnout dimensions. Specifically, it remains uncertain whether exhaustion (Leiter, 1989 ) or depersonalization (i.e., devaluation in sport) and accomplishment perceptions (Golembiewski, 1989 ) drive the overarching burnout experience for working professionals, but the possibilities are intriguing. Though support for these ideas in worker populations is still being established, it may be useful to assess potential developmental sequencing of burnout dimensions among athletes via the ABQ measurement. If we can identify a causal sequence between individual burnout symptoms and the overall burnout experience in sport, or perhaps point out alternative developmental patterns contingent upon particular individual differences (e.g., personality or dispositional attributes), researcher and clinician alike might be able to prevent burnout and provide treatment in sport. Because of the limited theoretical basis for this inquiry in sport, researchers should begin investigation cautiously, while strongly considering the possibility that a ubiquitous temporal sequencing may not exist in athlete populations.

Another area ripe for athlete burnout research is the role played by various sport-based social actors involved in preventing, attenuating, and (in some instances) exacerbating athlete burnout. These actors could include sports medicine or psychology clinicians, parents, coaches, spectators, or even media involved in conveying sport to the masses. Advancing understanding of perspectives on athlete burnout from these actors could build on previous work utilizing quantitative (survey), qualitative (interview), or mixed methods designs and extend further into experimental design or intervention evaluation studies. Specifically, further understanding of environmental social antecedents of burnout (e.g., social support, conflict) is needed to inform the development of psychoeducational interventions that utilize targeted social agents and their interactions with athletes as a means of burnout monitoring, prevention, and, when warranted, treatment.

Finally, longitudinal burnout monitoring efforts should be a feature of future research and, in particular, monitoring that includes biometric assessments. The previously mentioned foundational, longitudinal work has shed some light on the development of burnout in athlete samples, but research gaps remain in our understanding of variables moderating and mediating its progression. These gaps may start to be addressed via systematic monitoring during athletes’ intensive training and competitive periods as well as during less demanding (e.g., off-season) periods. Well-designed efforts, informed by relevant theory, to obtain data over time on relevant psychosocial and behavioral variables for monitoring and predictive purposes would advance knowledge on athlete burnout. The objective monitoring of biometric markers of health behaviors through “wearable” technology that is cost effective, portable, and user friendly merits further investigation in predicting the development of athlete burnout (Eklund & DeFreese, 2015 ). At present, the combination of these technologies with psychological assessments would be innovative for study in this area, and it may be longitudinally revealing. Improved understanding of these associations in athlete populations could ultimately inform the development of user-friendly applications to effectively monitor athlete burnout during training and/or competition.

Given the paucity of work in this area, and the many calls for research on athlete psychological health and well-being in an era of increased early sport specialization, the previously mentioned efforts merit extramural funding support. Hence, efforts to that end are encouraged. Interest in the long-term costs and benefits of sport participation will continue to grow among researchers and, more broadly, in contemporary society. Thus, the time is ripe for research efforts that track the development of athlete burnout over career-segments or entire careers via projects designed with both theory and practice (i.e., recognition, treatment) in mind.

Practical Applications

The rule changes and educational recommendations implemented by the International Tennis Federation, as described by Hume ( 1985 ), do not stand alone among organizational initiatives to address concerns about athlete burnout, but, to date, systematic examination of the effectiveness of practical strategies to prevent and/or mitigate burnout symptoms among athletes has been limited. Specifically, no reports of evaluations of interventions on athlete burnout exist in the extant literature that can provide a basis for suggestions or recommendations for clinical practice. For that reason, intervention strategies based on extant theory and athlete burnout research are cautiously recommended. Accordingly, clinical judgment is especially important in managing athlete burnout, and all techniques touched upon should be tailored to the unique needs of the individual athlete.

One way clinicians and/or athletes themselves can help to lower burnout-related perceptions is to employ strategies to manage or cope with psychosocial stress in training and/or sport participation. A variety of stress management techniques (e.g., imagery, relaxation training, mindfulness) may provide effective coping resources for competitive athletes. Moreover, cognitive strategies to help athletes minimize their initial stress appraisals (i.e., normalization of stress responses to training or competition) could also be helpful. Ultimately, any strategy that may minimize the athlete’s initial stress response and/or help the athlete to cope with the resulting stress could have a long-term effect in preventing and treating burnout symptoms. This idea is bolstered by earlier commentaries on theory and practice relative to sport coaches (e.g., Fletcher & Scott, 2010 ), whereby stress management and the effective utilization of coping strategies is highlighted as a key precursor of more adaptive outcomes of involvement within the stress-inducing environment of competitive sport.

Strategies to support athletes in developing adaptive patterns of sport identification and commitment could also be effective in preventing or treating burnout. For example, efforts to expand potentially unidimensional athletic identities by facilitating at least one nonsport interest (e.g., academics, music, art) could be helpful in deterring or mitigating burnout. Additionally, reminding athletes of the benefits and enjoyable aspects of sport relative to alternative activities could be beneficial in minimizing burnout symptoms from a commitment perspective (Raedeke, 1997 ; Schmidt & Stein, 1991 ) as well as indirectly promote perceived control for athletes within sporting environments which may, at times, minimize their choice to participate (Coakley, 1992 , 2009 ). Ultimately, regardless of the psychological and/or physical recovery strategies facilitated to promote positive athlete outcomes, continued sport participation, at least on an autonomous basis, is a choice that is often shaped by identity and control perceptions (Samuel & Tenenbaum, 2011 ). Having more complex, multifaceted self-identities may be more protective for athletes against maladaptive psychological health and well-being outcomes than having to rely solely on a strong exclusive athlete identity (Brewer, 1993 ; Van Raalte and Linder, 1999 ). Accordingly, competitive athletes with multifaceted self-identities and commitment patterns characterized by sport enjoyment may be less likely to develop burnout symptoms.

As previously observed, research has shown that more adaptive (i.e., self-determined) forms of motivation are associated with lower burnout in both cross-sectional and longitudinal study designs. Thus, efforts to shape the imperatives regulating athletes’ involvement in sport may be an effective strategy for combatting burnout for some athletes. Cognitive strategies to remind athletes of the inherently interesting (intrinsically motivating) aspects of sport could help promote more self-determined forms of motivation. Meanwhile, environmental strategies designed to enhance satisfaction of athletes’ psychological needs of competence, autonomy, and relatedness in sport may also be beneficial. Research has shown (see Li et al., 2013 , for a review) that these psychological needs perceptions by athletes positively impact self-determined motivation for sport and are both directly and indirectly associated with lower self-report athlete burnout scores.

Athlete perceptions of the social environment created by coaches, teammates, and parents have been associated with athlete burnout perceptions. Accordingly, strategies designed to improve athlete access to and utilization of social support from important sport-based social actors and to cope with negative social interactions or conflict could be helpful as burnout prevention and treatment efforts (e.g., DeFreese & Smith, 2014 , DeFreese et al., 2015 . Smith et al., 2010 ). For example, clinicians, coaches, or teammates could develop strategies to promote social assimilation and minimize social isolation in their athletic environments. These socially driven burnout prevention/intervention strategies may have added benefits for clubs such as the promotion of team task and social cohesion and/or the development of intrateam friendships and acceptance. Thus, such strategies are both preventative and responsive to burnout symptoms, while not singling out individual athletes for a specific psychological “issue.” This may be particularly helpful as there could be some actual or perceived social stigma for athletes who admit they are “burned-out” (cf. Cresswell & Eklund, 2006c ).

With the exception of the approaches mentioned above, environmental strategies are seldom recommended for burnout prevention and treatment because the onus is often put on the athletes themselves to “manage” their responses to their sport environments. Yet, other strategies to alter training and/or competition environments may also be helpful burnout interventions. For example, some sport environments may promote unreasonable amounts of stress, an all-or-nothing athletic identity, a thwarting of psychological needs, and/or a conflictual or isolating social environment. Accordingly, strategies to change sporting environments and to minimize the promotion of athlete burnout also warrant consideration. For example, techniques that help shape sport environments that promote athletic identities, stress levels, and motivational patterns that are less likely to yield “burned-out” athletes should be considered. These strategies could involve implementation of logistic changes such as training breaks (which may also address potential comorbid problems with the overtraining syndrome) and/or changes in training structure in order to increase novelty and motivation and prevent athlete boredom. Alternatively, leader-directed strategies such as autonomy supportive coaching (Mageua & Vallerand, 2003 ), which focus on providing athletes with choices and a rationale for coaching decisions, may also be helpful in structuring sport environments that are less likely to promote burnout. These efforts will likely require carefully educating coaches (Eklund & DeFreese, 2015 ) on how to support athletes’ autonomy without losing the control needed to properly instruct and develop their athletes both on and off the field.

To our knowledge, extant macrolevel efforts to manage and/or intervene upon burnout (i.e., excluding interventions conducted by therapists with individual athletes) have been largely limited to those conducted outside of sport in organizational or workplace spheres. Those efforts have had a primary focus on stress management (e.g., Ivancevich, Matteson, Freedman & Phillips, 1990 ; Munz, Kohler, & Greenberg, 2001 ). The results of such interventions have been promising, and, though differences between sport and work exist, such interventions may have usefulness for athletes. Ultimately, the appropriate transfer of such work-based intervention to sport may have benefits for stress management, burnout prevention, and, ultimately, the psychological health and well-being of athletes. Previously reviewed efforts in sport aimed at minimizing the stress and burnout of coaches could inform the development and assessment of such interventions with athletes (Fletcher & Scott, 2010 ). Efforts on the potential adaptation of the areas of worklife to sport (DeFreese et al., 2013a ) may also aid in the translation of coach-based interventions, with potential flow-on effects for athletes.

Finally, clinical awareness, discriminative judgment, and appropriate consultation or referral, if needed, are required in working with athletes who present as experiencing burnout because of its overlapping symptomatology with other conditions (e.g., depression, overtraining syndrome). As a first example, the commonalities in the burnout and overtraining syndromes (e.g., exhaustion, mood disturbances, concerns about the performance adequacy) are striking, but they can be clinically misleading. Excessive training stress, however, is not requisite for developing the athlete burnout syndrome (Eklund & Cresswell, 2007 ), even if it may sometimes contribute to the athlete’s psychosocial stress (e.g., Gould, Tuffey et al., 1997 ).

On a different note, amotivation is often regarded as the motivational signature of athlete burnout (Eklund & Cresswell, 2007 ). As noted by Kreher and Schwartz ( 2012 ), however, athletes suffering with the overtraining syndrome are often highly motivated and goal oriented, as indicated by their willingness to invest in even greater volume and intensity of training to address their concerns about underperformance and performance plateaus. Accordingly, these syndromes should be regarded as distinct conditions requiring intervention strategies that are not identical (Raglin, 1993 ). Selection of the appropriate intervention strategies requires proper recognition of the condition being experienced by the athlete, and the commonalities across these syndromes may be misleading in some instances.

The commonalities between burnout and depression have also long been recognized (Freudenberger, 1975 ; Glass & McKnight, 1996 ), including the overlapping presence of depressive cognitive styles (Bianchi & Schonfeld, 2016 ). Athletes dealing with burnout can have depressed moods, and depressed athletes can feel burned out, so symptomatology can be tangled. An important primary difference between burnout and clinical depression can be found in the experiential generality of the condition. Burnout tends to involve situational specificity of symptoms, at least during the early stages of burnout (Maslach, Jackson, & Leiter, 1997 ), whereas clinical depression involves symptomology that pervasively diminishes a person’s interest and pleasure in life (American Psychiatric Association, 2013 ). Despite the potentially misleading commonalities, proper recognition of the condition being experienced by the athlete is paramount in providing suitable intervention treatment from a properly trained clinical specialist as directly as possible.

Integrating Research and Practice

Despite future intervention possibilities with respect to athlete burnout, experts in sport science and sports medicine have expressed concerns that injury and a variety of undesirable psychological outcomes are embedded nontrivial risks for young athletes involved in early sport specialization (Smucny, Parikh, & Pandya, 2015 ). The American Orthopaedic Society for Sports Medicine, for example, has identified burnout in particular as a potential psychological health risk of early sport specialization for children and adolescents (LaPrade et al., 2016 ). This idea has been further bolstered by recommendations from pediatrics physicians to limit and carefully monitor youth sport specialization effects because of potentially aversive mental and physical health effects (Brenner & AAP Council on Sports Medicine and Fitness, 2016 ). An in-depth discussion of the potential risks (and benefits) of early sport specialization is beyond the scope of this commentary, but it should be noted that sport specialization is growing in importance in both sport science and popular culture. The potential impact over time of early sport specialization on the development of athlete burnout among elite performers remains unclear.

At the same time, sports medicine physicians have identified burnout as one of the most important noninjury issues that they address in interactions with athlete patients of any age (Mann, Grana, Indelicato, O’Neill, & George, 2007 ). Therefore, burnout is relevant to those who are invested in supporting the psychological health and well-being of athletes of all ages. Accordingly, longitudinal investigative designs are likely to be very important in advancing understanding of potential links between burnout and important related issues like early sport specialization and injury. The integration of research and practice may be the most productive way to understand and monitor the development of athlete burnout, while simultaneously providing medical and/or psychological services (nonclinical or clinical) to those athletes who may need to improve their psychological health. For these reasons, the integration of research and practice is of interest to both sports medicine staff and governing bodies with the means to support such integrative work.

As an example, burnout monitoring efforts (i.e., efforts designed to decrease stress, improve coping skills, and enhance social support utilization) could be augmented so as to be clinically useful as well. Psychosocial and biometric monitoring data could be utilized as a clinical decision-making tool designed to refer athletes to burnout interventions or other therapeutic programming (e.g., management of stress, the overtraining syndrome, or clinical mental health issues). If burnout monitoring reveals possible clinical anxiety or depression, the athlete could be referred to the appropriately credentialed mental health specialist (e.g., clinical psychologist). Thus, research could help develop an effective decision-making algorithm for burnout (or other mental health symptoms) referral decisions from monitoring data as well as examine feasibility and effectiveness issues in any implicated interventions with the identified athletes. Given the paucity of published sport-based intervention studies to date, drawing from burnout intervention studies employed in professional settings (e.g., Rollins et al., 2016 ) may benefit efforts in this area. Altogether, the combination of athlete burnout monitoring and intervention efforts outlined in this article could have positive and substantive effects on athletes’ psychological health and well-being, and represent an innovative future direction for clinical research in sport.

Who Can Help in the Prevention and/or Remediation of Athlete Burnout

Individuals directly involved in athlete training and talent development (i.e., coaches, administrators, teammates) are well positioned to notice the signs and symptoms of burnout (e.g., chronic exhaustion, reduced accomplishment, sport devaluation). These individuals could therefore be important agents in integrated efforts to monitor and conduct research on athlete burnout. Some individuals in this group (e.g., coaches), pleading time constraints and absence of relevant training, could question their effectiveness in burnout research and practice. For these individuals, educationally oriented involvement in burnout monitoring could be beneficial for athletes in their appraisals and responses to training and, perhaps ultimately, their performance outcomes.

At the same time, coaches may have considerable intuitive insight into athlete burnout. Raedeke, Lunney, and Venables ( 2002 ), for example, explored the question of how coaches draw conclusions about burnout after monitoring their athletes. They asked swimming coaches ( n = 13) to reflect on their opinions regarding the signs and antecedents of athlete burnout. The coaches generally characterized the symptoms of burnout in terms that were consistent with Raedeke’s ( 1997 ) conceptual definition but also included withdrawal from sport as symptomatic—the latter is considered a potential behavioral consequence of athlete burnout rather than being symptomatic per se (Eklund & Cresswell, 2007 ). Moreover, these coaches described the antecedents or causes of athlete burnout in swimming as including outside pressures (e.g., parents, coaches, friend), self-pressure, peer comparison, as well as issues related to swimming autonomy and identity. In sum, understanding burnout is crucial in developing talent and promoting psychological well-being in sport, and of course, coaches and athletic administrators are crucial to such efforts. Accordingly, their efforts relative to burnout prevention and remediation (as well as relative to differentiating symptomatologies across the overtraining and burnout syndromes) may aid greatly in athlete training and performance outcomes as well as in psychological health and well-being.

Those tasked with caring for the mental and physical health of athletes are also essential in the area of athlete burnout practice, including the monitoring, prevention, and treatment of athlete burnout. Specifically, within the scope of their practice, team members of sports medicine (athletic trainers, sports medicine physicians, clinical sport psychologists) need to be prepared for clinical recognition of the symptoms of burnout among athletes (and able to distinguish burnout from other psychological health or maladaptive training response issues). Consequently, when symptoms merit it, these individuals should also be prepared to properly refer athletes to professionals with more specialized treatment expertise. This is especially true for issues of clinical mental health. In sum, collaboration among researchers, practitioners, coaches/administrators, and athletes themselves to improve athlete responses to training and competition is necessary for effective research and practice relative to burnout in sport. Communication among sports medicine team members and those tasked with talent development will likely produce the best outcomes for athletes relative to burnout. Consequently, when burnout is recognized in the athletes they serve, these individuals can work together to most effectively manage this negative psychological response and to promote more adaptive sport-based psychological outcomes.

• American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• Appleton, P. R. , & Hill, A. P. (2012). Perfectionism and athlete burnout in junior elite athletes: The mediating role of motivation regulations. Journal of Clinical Sports Psychology , 6 , 129–145.
• Barcza-Renner, K. , Eklund, R. C. , Morin, A. J. S. , & Habeeb, C. M. (2016). Controlling coaching behaviors and athlete burnout: Investigating the mediating roles of perfectionism and motivation. Journal of Sport and Exercise Psychology , 38 , 30–44.
• Black, J. M. , & Smith, A. L. (2007). An examination of Coakley’s perspective on identity, control, and burnout among adolescent athletes. International Journal of Sport Psychology , 38 , 417–436.
• Brenner, J. S. , & AAP Council on Sports Medicine and Fitness (2016). Sport specialization and intensive training in young athletes. Pediatrics , 138 , e2016–e2148.
• Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed mood. Journal of Personality , 61 , 343–364.
• Coakley, J. (1992). Burnout among adolescent athletes: A personal failure or social problem? Sociology of Sport Journal , 9 , 271–285.
• Coakley, J. (2009). From the outside in: Burnout as an organizational issue. Journal of Intercollegiate Sports , 2 , 35–41.
• Cohn, P. J. (1990). An exploratory study on sources of stress and athlete burnout in youth golf. The Sport Psychologist , 4 , 95–106.
• Cresswell, S. L. , & Eklund, R. C. (2004). The athlete burnout syndrome: Possible early signs. Journal of Science and Medicine in Sport , 7 , 481–487.
• Cresswell, S. L. , & Eklund, R. C. (2005a). Changes in athlete burnout and motivation over a 12-week league tournament. Medicine and Science in Sports and Exercise , 37 , 1957–1966.
• Cresswell, S. L. , & Eklund, R. C. (2005b). Motivation and burnout in professional rugby players. Research Quarterly for Exercise and Sport , 76 , 370–373.
• Cresswell, S. L. , &. Eklund, R. C. (2005c). Motivation and burnout among top amateur rugby players. Medicine and Science in Sport and Exercise , 37 , 469–477.
• Cresswell, S. L. , & Eklund, R. C. (2006a). Changes in athlete burnout over a 30-wk “rugby year.” Journal of Science and Medicine in Sport , 9 , 125–134.
• Cresswell, S. L. , & Eklund, R. C. (2006b). The convergent and discriminant validity of burnout measures in sport: A multi-trait/multi-method analysis. Journal of Sports Sciences , 24 , 209–220.
• Cresswell, S. L. , & Eklund, R. C. (2006c). The nature of player burnout in rugby: Key characteristics and attributions. Journal of Applied Sport Psychology , 18 , 219–239.
• Cresswell, S. C. , & Eklund, S. L. (2007). Athlete burnout: A longitudinal qualitative study. The Sport Psychologist , 21 , 1–20.
• Curran, T. , Appleton, P. R. , Hill, A. P. , & Hall, H. K. (2011). Passion and burnout in elite junior soccer players: The mediating role of self-determined motivation. Psychology of Sport and Exercise , 12 , 655–661.
• Dale, J. , & Weinberg, R. (1990). Burnout in sport: A review and critique. Journal of Applied Sport Psychology , 2 , 67–83.
• Deci, E. L. , & Ryan, R. M. (1985). Intrinsic motivation and self-determined human behavior . New York: Plenum Press.
• DeFreese, J. D. , & Smith, A. L. (2013a). Areas of worklife and the athlete burnout–engagement relationship. Journal of Applied Sport Psychology , 25 , 180–196.
• DeFreese, J. D. , & Smith, A. L. (2013b). Teammate social support, burnout, and self-determined motivation in collegiate athletes. Psychology of Sport and Exercise , 14 , 258–265.
• DeFreese, J. D. , & Smith, A. L. (2014). Athlete social support, negative social interactions, and psychological health across a competitive sport season. Journal of Sport and Exercise Psychology , 36 , 619–630.
• DeFreese, J. D. , Smith, A. L. , & Raedeke, T. D. (2015). Individual and organizational solutions to athlete burnout. In J. M. Williams & V. Krane (Eds.), Applied sport psychology (pp. 444–461 ) , New York: McGraw-Hill.
• Eklund, R. C. , & Cresswell, S. L. (2007). Athlete burnout. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology (3d ed., pp. 621–641). Hoboken, NJ: Wiley.
• Eklund, R. C. , & DeFreese, J. D. (2015). Athlete burnout: What we know, what we could know, and how we can find out more. International Journal of Applied Sport Science , 27 , 63–75.
• Feigley, D. A. (1984). Psychological burnout in high-level athletics. The Physician and Sportsmedicine , 12 , 109–119.
• Fletcher, D. , & Scott, M. (2010). Psychological stress in sports coaches: A review of concepts, research, and practice. Journal of Sports Sciences , 28 , 127–137.
• Freudenberger, H. J. (1974). Staff burn-out. Journal of Social Issues , 30 , 159–165.
• Freudenberger, H. J. (1975). The staff burn-out syndrome in alternative institutions. Psychotherapy: Theory, Research and Practice , 12 , 73–82.
• Garden, A. M. (1987). Depersonalization: A valid dimension of burnout? Human Relations , 40 , 545–560.
• Glass, D. C. , & McKnight, J. D. (1996). Perceived control, depressive symptomatology, and professional burnout: A review of evidence. Psychology and Health , 11 , 23–48.
• Golembiewski, R. T. (1989). A note on Leiter’s study: Highlighting two models of burnout. Group and Organization Studies , 14 , 5–13.
• González, L. , García-Merita, M. , Castillo, I. , & Balaguer, I. (2015). Young athletes’ perceptions of coach behaviors and their implications on their well-being and ill-being over time. Journal of Strength and Conditioning Research , 30 , 1147–1154.
• Goodger, K. , Gorely, T. , Lavallee, D. , & Harwood, C. (2007). Burnout in sport: A systematic review. The Sport Psychologist , 21 , 127–151.
• Gould, D. (1993). Intensive sport participation and the prepubescent athlete: Competitive stress and burnout. In B. R. Cahil & A. J. Pearl (Eds.), Intensive participation in children’s sport (pp. 19–38). Champaign, IL: Human Kinetics.
• Gould, D. (1996). Personal motivation gone awry: Burnout in competitive athletes. Quest , 48 , 275–289.
• Gould, D. , Tuffey, S. , Udry, E. , & Loehr, J. (1996) Burnout in competitive junior tennis players: II. Qualitative analysis. The Sport Psychologist , 10 , 341–366.
• Gould, D. , Tuffey, S. , Udry, E. , & Loehr, J. (1997). Burnout in competitive junior tennis players: III. Individual differences in the burnout experience. The Sport Psychologist , 11 , 256–276.
• Gould, D. , Udry, E. , Tuffey, S. , & Loehr, J. (1996). Burnout in competitive junior tennis players: I. A quantitative psychological assessment. The Sport Psychologist , 10 , 322–340.
• Gustafsson, H. , Hassmén, P. , Kenttä, G. , & Johansson, M. (2008). A qualitative analysis of burnout in elite Swedish athletes. Psychology of Sport and Exercise , 9 , 800–816.
• Gustafsson, H. , Kenttä, G. , Hassmén, P. , Lundqvist, C , & Durand-Bush, N. (2007). The process of burnout: A multiple case study of three elite endurance athletes. International Journal of Sport Psychology , 38 , 388–416.
• Henschen, K. (1990). Prevention and treatment of athletic staleness and burnout. Science Periodical on Research and Technology in Sport , 10 , 1–8.
• Hodge, K. , Lonsdale, C. , & Ng, J. Y. (2008). Burnout in elite rugby: Relationships with basic psychological needs fulfillment. Journal of Sports Sciences , 26 , 835–844.
• Hume, J. (1985). The burnout-the solution . London: International Tennis Federation.
• Isoard-Gautheur, S. , Guillet-Descas, E. , Gaudreau, P. , & Chanal, J. (2015). Development of burnout perceptions during adolescence among high level athletes: A developmental and gendered perspective. Journal of Sport and Exercise Psychology , 37 , 436–448.
• Ivancevich, J. M. , Matteson, M. T. , Freedman, S. M. , & Phillips, J. S. (1990). Worksite stress management interventions. American Psychologist , 45 , 253–261.
• Jowett, G. E. , Hill, A. P. , Hall, H. K. , & Curran, T. (2013). Perfectionism and junior athlete burnout: The mediating role of autonomous and controlled motivation. Sport, Exercise, and Performance Psychology , 2 , 48–61.
• Kreher, J. B. , & Schwartz, J. B. (2012). Overtraining syndrome: A practical guide . Sports Health , 4 (2), 128–138.
• LaPrade, R. F. , Agel, J. , Baker, J. , Brenner, J. S. , Cordasco, F. A. , Cȏté, J. , et al. (2016). AAOSSM early sport specialization consensus statement . The Orthopaedic Journal of Sports Medicine , 4 , 2325967116644241.
• Lazarus, R. S. (1966). Psychological stress and the coping process . New York: McGraw-Hill.
• Lazarus, R. S. (1982). Thoughts on the relation between emotion and cognition. American Psychologist , 37 , 1019–1024.
• Leiter, M. P. (1989). Conceptual implications of two models of burnout: A response to Golembiewski. Group and Organization Studies , 14 , 15–22.
• Leiter, M. P. , & Maslach, C. (2004). Areas of worklife: A structured approach to organizational predictors of job burnout. In P. L. Perrewe & D. C. Ganster (Eds.), Research in occupational Stress and well-being . Oxford: Elsevier.
• Lemyre, P.-N. , Hall, H. K. , & Roberts, G. C. (2008). A social cognitive approach to burnout in elite athletes. Scandinavian Journal of Medicine and Science in Sports , 18 , 221–234.
• Lemyre, P.-N. , Roberts, G. C. , & Stray-Gundersen, J. (2007). Motivation, overtraining, and burnout: Can self-determined motivation predict overtraining and burnout in elite athletes? European Journal of Sport Science , 7 , 115–126.
• Lemyre, P.-N. , Treasure, D. C. , & Roberts, G. C. (2006). Influence of variability in motivation and affect on elite athlete burnout susceptibility. Journal of Sport and Exercise Psychology , 28 , 32–48.
• Li, C. , Wang, C. K. J. , Pyun, D. Y. , & Kee, Y. H. (2013). Burnout and its relations with basic psychological needs and motivation among athletes: A systematic review and meta-analysis. Psychology of Sport and Exercise , 14 , 692–700.
• Lonsdale, C. , & Hodge, K. (2011). Temporal ordering of motivational quality and athlete burnout in elite sport. Medicine and Science in Sports and Exercise , 43 , 913–921.
• Lonsdale, C. , Hodge, K. & Rose, E. A. (2006). Pixels vs. paper: Comparing online and traditional survey methods in sport psychology. Journal of Sport and Exercise Psychology , 28 , 100–108.
• Lonsdale, C. , Hodge, K. , & Rose, E. (2009). Athlete burnout in elite sport: A self-determination perspective. Journal of Sport Sciences , 27 , 785–795.
• Madigan, D. J. , Stoeber, J. & Passfield, L. (2015). Perfectionism and burnout in junior athletes: A three-month longitudinal study. Journal of Sport and Exercise Psychology , 37 , 305–315.
• Madigan, D. J. , Stoeber, J. & Passfield, L. (2016). Motivation mediates the perfectionism-burnout relationship: A three-wave longitudinal study with junior athletes. Journal of Sport and Exercise Psychology 38 , 341–354.
• Mageua, G. A. , & Vallerand, R. J. (2003). The coach-athlete relationship: A motivational model. Journal of Sports Science , 21 , 883–904.
• Mann, B. J. , Grana, W. A. , Indelicato, P. A. , O’Neill, D. F. , & George, S. Z. (2007). A survey of sports medicine physicians regarding psychological issues in patient-athletes. American Journal of Sports Medicine , 35 , 2140–2147.
• Marsh, H. W. (1998). Foreword. In J. L. Duda (Ed.), Advances in sport and exercise psychology measurement (pp. xv–xix). Champaign, IL: Human Kinetics.
• Maslach, C. (1982). Burnout: The cost of caring . London: Prentice-Hall.
• Maslach, C. , & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Psychology , 2 , 99–113.
• Maslach, C. , & Jackson, S. E. (1986). Maslach burnout inventory manual (2d ed.). Palo Alto, CA: Consulting Psychologists Press.
• Maslach, C. , Jackson, S. E. , & Leiter, M. P. (1996). Maslach burnout inventory manual (3d ed.). Palo Alto, CA: Consulting Psychologists Press.
• Maslach, C. , Jackson, S. E. , & Leiter, M. P. (1997). Maslach burnout inventory. In C. P. Zalaquett & R. J. Wood (Eds.), Evaluating stress: A book of resources (3d ed., pp. 191–218). London: Scarecrow Press.
• Maslach, C. , Schaufeli, W. B. , & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology , 52 , 397–422.
• Munz, D. C. , Kohler, J. M. , & Greenberg, C. I. (2001). Effectiveness of a comprehensive worksite stress management program: Combining organizational and individual interventions. International Journal of Stress Management , 8 , 49–62.
• Perreault, S. , Gaudreau, P. , Lapointe, M.-C. , & Lacroix, C. (2007). Does it take three two tango? Psychological need satisfaction and athlete burnout. International Journal of Sport Psychology , 38 , 437–450.
• Price, M. S. , & Weiss, M. R. (2000). Relationships among coach burnout, coach behaviors, and athletes’ psychological responses. The Sport Psychologist , 14 , 391–409.
• Raedeke, T. D. (1997). Is athlete burnout more than just stress? A sport commitment perspective. Journal of Sport and Exercise Psychology , 19 , 396–417.
• Raedeke, T. D. , Lunney, K. , & Venables, K. (2002). Understanding athlete burnout: Coach perspectives. Journal of Sport Behavior , 25 , 181–206.
• Raedeke, T. D. , & Smith, A. L. (2001). Development and preliminary validation of an athlete burnout measure. Journal of Sport and Exercise Psychology , 23 , 281–306.
• Raedeke, T. D. , & Smith, A. L. (2004). Coping resources and athlete burnout: An examination of stress mediated and moderation hypotheses. Journal of Sport and Exercise Psychology , 26 , 525–541.
• Raedeke, T. D. , & Smith, A. L. (2009). The Athlete Burnout Questionnaire manual . Morgantown: West Virginia University.
• Raglin, J. S. (1993). Overtraining and staleness: Psychometric monitoring of endurance athletes. In R. B. Singer , M. Murphey , & L. K. Tennant (Eds.), Handbook of research on sport psychology (pp. 840–850). New York: Macmillan.
• Rollins, A. L. , Kukla, M. , Morse, G. , Davis, L. , Leiter, M. , Monroe-DeVita, M. , et al. (2016). Comparative effectiveness of a burnout reduction intervention for behavioral health providers. Psychiatric Services , 67 , 920–923.
• Rotella, R. J. , Hanson, T. , & Coop, R. H. (1991). Burnout in youth sport. The Elementary School Journal , 91 , 421–428.
• Rowland, T. W. (1986). Exercise fatigue in adolescents: Diagnosis of athlete burnout. The Physician and Sports Medicine , 14 , 69–77.
• Ryan, R. M. , & Deci, E. L. (2000a). The darker and brighter sides of human existence: Basic psychological needs as a unifying concept. Psychological Inquiry , 11 , 319–338.
• Ryan, R. M. , & Deci, E. L. (2000b). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist , 55 , 68–78.
• Samuel, R. D. , & Tenenbaum (2011). The role of change in athletes’ careers: A scheme of change for sport psychology practice. The Sport Psychologist , 25 , 233–252.
• Schaufeli, W. B. , & Enzmann, D. (1998). The burnout companion to study and practice: A critical analysis . Washington, DC: Taylor & Francis.
• Schellenberg, B. J. I. , Gaudreau, P. , & Crocker, P. R. E. (2013). Passion and coping: Relationships with changes in burnout and goal attainment in collegiate volleyball players. Journal of Sport and Exercise Psychology , 35 , 270–280.
• Schmidt, G. W. , & Stein, G. L. (1991). Sport commitment: A model integrating enjoyment, dropout, and burnout. Journal of Sport and Exercise Psychology , 13 , 254–265.
• Schonfeld, I. S. & Bianchi, R. (2016). Burnout and depression: Two entities or one? Journal of Clinical Psychology , 72 , 22–37.
• Silva, J. M. (1990). An analysis of the training stress syndrome in competitive athletics. Journal of Applied Sport Psychology , 2 , 5–20.
• Smith, A. L. , Gustafsson, H. , & Hassmén, P. (2010). Peer motivational climate and burnout perceptions of adolescent athletes. Psychology of Sport and Exercise , 11 , 453–460.
• Smith, R. E. (1986). Toward a cognitive-affective model of athletic burnout. Journal of Sport Psychology , 8 , 36–50.
• Smucny, M. , Parikh, S. N. , & Pandya, N. K. (2015). Consequences of single sport specialization in the pediatric and adolescent athlete. Orthopedic Clinics of North America , 46 , 249–258.
• Thibaut, J. W. , & Kelley, H. H. (1959). The social psychology of groups . New York: Wiley.
• Van Raalte, J. L. , & Linder, D. E. (1999). Athletic identity: Hercules’ muscles or Achilles heel? International Journal of Sport Psychology , 24 , 237–254.
• Vealey, R. S. , Armstrong, L. , Comar, W. , & Greenleaf, C. A. (1998). Influence of perceived coaching behaviors on burnout and competitive anxiety in female college athletes. Journal of Applied Sport Psychology , 10 , 297–318.
• Yukelson, D. (1990). Psychological burnout in sport participants. Sports Medicine Digest , 12 , 4.

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ORIGINAL RESEARCH article

The influence of athletes’ gratitude on burnout: the sequential mediating roles of the coach–athlete relationship and hope.

• 1 School of Physical Education, China University of Geoscience, Wuhan, China
• 2 School of Physical Education, Central China Normal University, Wuhan, China
• 3 School of Physical Education, Yangzhou University, Yangzhou, China

Background: Athlete burnout is a widespread psychological syndrome in competitive sports, negatively impacts athletes’ competitive state and hampers the healthy development of sports organizations. With the rise of positive psychology, exploring the mechanisms of athlete psychological fatigue through the lens of psychological capital has become a focal point of recent research. This study introduces gratitude, a key element of psychological capital in positive psychology, to examine its effect on athlete burnout and its mechanism of action, with a particular focus on the sequential mediating roles of the coach-athlete relationship (CAR) and hope.

Method: A cross-sectional study design was utilized, involving 483 active Chinese athletes from national training teams and professional sports teams. The sample comprised both male (n=251) and female (n=232) athletes, with an average age of 19.24 ± 3.99 years. Participants were asked to complete self-administered questionnaires, including the Gratitude Questionnaire, CAR Questionnaire, Hope Questionnaire, and Athlete Burnout Questionnaire. Structural equation modeling in AMOS 24.0 and descriptive statistics and correlation analyses in SPSS 20.0 were employed for data analysis.

Results: The study revealed significant associations between athlete gratitude, CAR, hope, and athlete burnout. Notably, gratitude was found to both directly and indirectly (via CAR and hope) influence burnout levels among athletes, suggesting a sequential mediation effect.

Conclusion: The findings highlight the importance of positive psychological constructs in buffering against athlete burnout. Specifically, gratitude, alongside a supportive CAR and elevated levels of hope, may play crucial roles in mitigating burnout symptoms. These insights offer promising directions for the development of targeted intervention strategies aimed at fostering athlete well-being and performance, advocating for the integration of positive psychology principles in the management and prevention of athlete burnout.

1 Introduction

In the dynamic environment of competitive sports, athletes are subject to an array of pressures, including stringent performance expectations, rigorous selection processes, and elevated risks of injury. These challenges contribute significantly to the prevalence of psychological burnout among athletes, a state characterized by emotional exhaustion, a diminished sense of achievement, and devaluation of sports participation ( Raedeke and Smith, 2001 ; Gustafsson et al., 2017 ). Furthermore, psychological burnout adversely impacts an athlete’s well-being and performance, as well as team dynamics and cohesion ( Isoard-Gautheur et al., 2016 ).

The advent of positive psychology has shifted focus toward the exploration of how positive mental states and emotions, notably gratitude, can serve as a buffer against athlete burnout. Gratitude, identified as a fundamental virtue within positive psychology, is posited to promote well-being and mitigate symptoms of burnout ( Wood et al., 2009 ). Despite the broad positive outcomes associated with gratitude, such as enhanced positive emotions, well-being, prosocial behavior, and spirituality/religiosity ( McCullough et al., 2002 ), the specific mechanisms through which gratitude impacts burnout among professional athletes remain underexplored, indicating a critical gap in research.

This study aims to address this gap by examining the influence of athletes’ gratitude on burnout within the professional sports context, with a particular emphasis on the sequential mediating roles of the coach-athlete relationship (CAR) and hope. This approach not only seeks to extend the theoretical framework pertaining to gratitude in sports psychology but also endeavors to reveal practical interventions for alleviating athlete burnout. Hence, the significance of this research lies in its potential to deepen our understanding of the role of positive psychology in sports, especially through the lens of gratitude and its mediating effects on preventing and managing athlete burnout.

In summary, this investigation into the effects of gratitude on athlete burnout among professional athletes fills an essential gap in the literature, offering a nuanced understanding of how gratitude, in conjunction with supportive relationships and hope, can form a vital component in the psychological toolkit against burnout, ultimately fostering athletes’ well-being and success in competitive sports.

2 Theoretical background and research hypotheses

Within the competitive sports domain, athlete burnout is characterized as a decrement in psychological functioning, precipitated by the continuous depletion of mental and physiological resources due to internal and external pressures, absent sufficient recovery. Manifestations of this condition include three primary dimensions: emotional/physical exhaustion, reduced sense of personal accomplishment, and a devaluation of sports participation ( Zhang et al., 2006 ). Table 1 presents the archetypal symptoms associated with each dimension. Previous research has demonstrated that burnout can have detrimental effects on athletes’ physical and mental health, potentially impairing performance, undermining social relationships, and leading to a discontinuation of sports participation ( Raedeke and Smith, 2001 ; Zhang, 2010 ; Zhang et al., 2014 ).

Table 1 . A synopsis of typical symptoms of burnout.

Research into athlete burnout has historically employed Smith’s (1986) , viewing burnout as a culmination of chronic stress. Moreover, investigators have deployed various theoretical frameworks to explore this phenomenon, including the Negative Training Stress Response Model, the Identity Development and External Control Model, and the Athletic Commitment Model. The advent of positive psychology has introduced a novel perspective, incorporating constructs of psychological capital to examine the underlying mechanisms of athlete burnout, indicating a critical shift in contemporary research trajectories ( Zhang et al., 2014 ; Ye et al., 2016b ).

Theoretical research suggests that gratitude may help alleviate athlete burnout. Fredrickson (2004) posited that gratitude, a positive emotion, has the potential to broaden individuals’ thought processes and foster creative thinking, as proposed by the Broaden-and-Build Theory. This cognitive broadening can lead to novel approaches in expressing gratitude, reciprocating to others, developing loving and thankful skills, and building friendships and social networks. These resources, in turn, become enduring personal assets that enhance resilience to stress and adversity. Consequently, they are less likely to resort to negative coping strategies such as avoidance, self-blame, substance abuse, or denial, which could mitigate the adverse effects of athlete burnout. Empirical research substantiates the adaptive benefits of gratitude in reducing psychopathological symptoms, such as depression and post-traumatic stress disorder, significantly improving subjective well-being and self-efficacy, and boosting physical health ( Tennen et al., 2009 ; Wood et al., 2009 ). Furthermore, studies have found that gratitude improves sleep quality, which, in turn, boosts physical health ( Wood et al., 2009 ). It is also a significant predictor of a decrease in symptoms like dizziness and headaches ( Froh et al., 2009 ).

Considering the established research, our study seeks not merely to reaffirm the negative correlation between gratitude and athlete burnout but to delve deeper into this relationship. Specifically, we aim to explore how gratitude interacts with other psychological constructs within the athletic context and its impact on the multifaceted nature of burnout. Therefore, this paper advances the hypothesis:

H1 : Gratitude is a significant negative predictor of athlete burnout, with our study providing further insight into its role and interactions within the context of competitive sports.

Previous studies have shown that the onset and progression of athlete burnout are associated with a spectrum of physiological, psychological, and sociological factors. The coach-athlete relationship (CAR) and hope are recognized as pivotal mediators in how gratitude might affect athlete burnout. CAR involves a dynamic interaction of emotional, cognitive, and behavioral elements between coaches and athletes. Meanwhile, hope refers to the experiential success resulting from the synergistic operation of pathway and agency thought processes during the pursuit of goals, representing cognitive and behavioral inclinations.

The moral affect theory of gratitude highlights the importance of moral motivation, suggesting that feelings of gratitude can lead to increased prosocial behaviors and motivations, such as altruism, care, sharing, and forgiveness. It also prompts a proactive search for opportunities to reciprocate to benefactors ( McCullough et al., 2001 ). Individuals with high levels of gratitude tend to experience fewer interpersonal conflicts and societal obstacles ( Gan, 2012 ). Algoe et al. (2008) examined the impact of gratitude among sorority members and found that greater gratitude in recipients led to better quality in establishing and maintaining interpersonal relationships. Further, Algoe et al. (2012) discovered that expressions of gratitude in one romantic partner significantly enhanced the perceived responsiveness of the other partner, which was predictive of relationship improvements over a six-month trajectory.

In the field of athletics, athletes with high levels of gratitude seek to understand their coaches’ perspectives during crises within the CAR. They appreciate the coach’s dedication and efforts and seek to mend the relationship ( Wang et al., 2014 ). Qualitative studies on athlete burnout have identified that a harmonious CAR, characterized by effective communication, active listening, and empathetic concern from the coach, can provide athletes with greater social support, thereby mitigating the negative impact of burnout attributed to sports activity ( Cresswell and Eklund, 2005 ). Moreover, positive social interactions, such as valuable advice, timely encouragement, and assistance, have been found to correlate negatively with sports-related athlete burnout ( DeFreese and Smith, 2014 ). In summary, gratitude not only promotes harmonious interpersonal relationships but also fosters the development of the CAR, which is closely associated with athlete burnout. Consequently, this paper proposes the hypothesis:

H2 : The CAR mediates the effect of athletes' gratitude on their burnout.

The broaden-and-build theory of positive emotions posits that gratitude can lead individuals to positively assess their present and future, fostering prosocial behaviors that foster social cohesion and strengthen interpersonal resources ( Fredrickson and Branigan, 2005 ). These interpersonal resources, in turn, expand individuals’ coping strategies when faced with stress, aligning with the pathways thinking aspect of hope theory. Additionally, gratitude reinforces motivation; individuals with high levels of gratitude report greater recognition of social support from others, including parental upbringing, coaching, and friendship. This increased recognition is manifested as sustained passion and motivation during training and competitions, in harmony with the agency thinking aspect of hope theory. Individuals with high hope levels, who exhibit strong agency and pathways thinking, tend to view stressors as challenges and are more likely to engage in positive actions ( Snyder, 2000 ). Furthermore, research indicates that hope alleviates burnout among college athletes, enhances achievement motivation, and stimulates learning interest ( Xie et al., 2016 ). In sports, hope is inversely related to the three dimensions of burnout; athletes with higher hope levels report significantly lower burnout scores. Moreover, hope not only directly reduces sports-related burnout but also serves as an indirect influence through the mediating effects of positive emotions and perceived stress (Gustafsson, 2010; Gustafsson et al., 2011 ). Therefore, this paper proposes the hypothesis:

H3 : Hope mediates the relationship between athletes' gratitude and their burnout.

Hope emerges from stable and secure attachment relationships and is closely connected to social connectedness ( Snyder, 2002 ). As social groups develop, they commonly establish ideologies and norms. To align with the group’s collective standards, individuals engage in cooperation within the group and intra-group competition, which simultaneously enhances their agency thinking. Additionally, within social groups, members offer mutual support and actionable advice, aiding in the identification of concrete methods to achieve collective goals, thus enhancing individuals’ pathways thinking. A harmonious and effective CAR promotes more positive and effective communication ( Jowett, 2012 ). Such a relationship significantly increases an athlete’s hope level and, through hope, increases satisfaction with athletic performance while reducing the negative effects of external pressures ( Ye, 2016b ). There is a clear link between athletes’ gratitude and the CAR, which affects the athletes’ hope level, and consequently, hope predicts athlete burnout. Consequently, this study proposes the following hypothesis:

H4 : The CAR and hope act as serial mediators between athletes' gratitude and athlete burnout.

3.1 Research design and sampling method

This study adopted a convenience sampling strategy to select athletes from national training teams and professional sports teams across varied provinces and cities, including Beijing, Hubei, Zhejiang, Heilongjiang, Guangdong, and Yunnan. In total, 502 questionnaires were distributed, and 483 valid responses were received, resulting in an effective response rate of 96.2%. The participant demographic was composed of 251 males (52.0%) and 228 females (47.2%), with gender information missing for 4 participants. Additionally, 11 participants (2.3%) did not specify their competition level. The average age of the athletes was 19.24 years (SD = 3.99), and the average training duration was 6.86 years (SD = 3.55). Athletes’ competition levels varied, including secondary level (40 participants), first level (218 participants), national master level (180 participants), and international master level (34 participants), with 11 participants not specifying their level.

The survey included a broad range of sports disciplines, such as marathon, martial arts, gymnastics, shooting, archery, clay pigeon shooting, cycling, triathlon, modern pentathlon, swimming, canoeing, middle and long-distance running, weightlifting, basketball, volleyball, boxing, judo, taekwondo, wrestling, high jump, tennis, and equestrian. The convenience sampling method facilitated rapid and efficient access to a diverse group of professional athletes, offering a practical solution amidst constraints of resources and time, despite the potential limitations in statistical representation inherent to this sampling method. Our direct engagement with athletes at their training bases and schools enhanced the depth and authenticity of the collected data.

3.2 Data collection procedure

The data collection process was rigorously designed to adhere to ethical guidelines, safeguarding the privacy and confidentiality of participant data. This study received ethical clearance from the Institutional Review Board (IRB) of Central China Normal University, emphasizing our commitment to conducting research with the utmost integrity and respect for participant welfare. Data collection was executed on a team basis using a group testing method, allowing for an extensive reach across a diverse range of athletes. Prior to data collection, explicit consent was obtained from both team leaders and athletes, ensuring their informed participation. Furthermore, participants were compensated for their valuable contribution to the research.

The task of collecting data was entrusted to graduate students specializing in sports psychology, all of whom had received rigorous training to perform this role efficiently. This team’s expertise guaranteed the precision and effectiveness of the data collection process. To protect participant privacy, all questionnaires were completed anonymously. Participants were assured of the strict confidentiality of their responses, which would be used solely for scientific analysis. Detailed instructions were provided to encourage thorough and independent responses, thus ensuring the data’s authenticity and reliability. Each participant was given approximately 20 min to complete the questionnaire, which was then immediately collected on-site to maintain data integrity.

Employing an on-site data collection strategy not only improved the response rate but also the accuracy and reliability of the collected data, thereby significantly enhancing the research’s quality and integrity. Our systematic approach in recruiting participants actively engaged in structured training environments, coupled with a rigorous review of returned questionnaires, further solidified the validity of our findings. This meticulous attention to ethical standards and data collection methodology underscores our dedication to producing credible and ethically sound research outcomes.

3.3 Measures

3.3.1 gratitude questionnaire.

The study employed the Gratitude Questionnaire (GQ) as adapted by Chen and Kee (2008) , which was originally developed by McCullough et al. (2002) . This scale employs a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), where higher scores reflect higher levels of gratitude. The questionnaire is composed of 5 items, including “Listing everyone I feel grateful to during my sporting career would be a lengthy process,” with the third item being reverse-scored. Confirmatory factor analysis indicated the following results: χ2/df = 12.34, indicating good structural validity for this version of the questionnaire. The original English version of the GQ had a reliability coefficient of 0.87 ( McCullough et al., 2002 ). In the present study, the overall reliability of the Gratitude Scale was found to be 0.80, indicating good reliability. The GQ total score showed a moderate correlation with several theoretical constructs relevant to the scale (namely happiness, optimism, agreeableness, and extraversion), which suggests good criterion-related validity ( Chen et al., 2009 ).

3.3.2 Athlete burnout questionnaire

The study utilized the Athlete Burnout Questionnaire (ABQ) in its form revised by Zhang et al. (2010) , which was originally developed by Raedeke and Smith (2001) . The scale employs a Likert 5-point scale (1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always), where higher scores denote higher levels of psychological burnout, and lower scores reflect lower levels. It comprises 15 items, such as “Training tires me out so much that I do not have the energy to do other things,” and “I am unable to concentrate during competitions as I used to,” and includes three subscales: emotional/physical exhaustion, reduced sense of accomplishment, and devaluation in sport. These subscales account for 61.66% of the variance. Confirmatory factor analysis utilizing the maximum likelihood estimation on a first-order three-factor model of the Athlete Burnout Questionnaire yielded: χ 2 /df = 4.29, RMSEA = 0.08, SRMR = 0.05, GFI = 0.91, NFI = 0.87, CFI = 0.90, IFI = 0.90, suggesting good construct validity for this iteration. The subscales’ reliabilities for emotional/physical exhaustion, reduced sense of accomplishment, and sport devaluation, as translated into Chinese by Lu et al. (2006) , were 0.88, 0.87, and 0.70, respectively. The scale’s overall reliability was measured at 0.78 in this study, with the subscales for emotional/physical exhaustion, reduced sense of accomplishment, and sport devaluation recording reliabilities of 0.78, 0.78, and 0.62 respectively, confirming good reliability. The scale demonstrated a significant positive relationship against the Chinese version of the ABQ translated by Lu et al. (2006) , supporting good criterion-related validity.

3.3.3 CAR questionnaire

The study employed the CAR Questionnaire (CART-Q) following the revisions of Zhong and Wang (2007) , adapted from the Greek version of the CART-Q developed by Jowett and Ntoumanis (2004) . This questionnaire utilizes a Likert 5-point scale (1 = strongly disagree; 2 = disagree; 3 = somewhat agree; 4 = mainly agree; 5 = strongly agree) for scoring, with higher scores signifying more positive coach-athlete relationships (CARs) and lower scores denoting less satisfactory relationships. It features 15 items, such as “I am loyal to my coach and am willing to maintain a long-term cooperation with him,” and “I am open to my coach’s advice and suggestions,” covering three dimensions: closeness, commitment, and complementarity, which account for 64.525% of the variance. Confirmatory factor analysis revealed: χ2/df = 4.98, RMSEA = 0.081, SRMR = 0.049, GFI = 0.90, NFI = 0.89, CFI = 0.91, IFI = 0.91. The original CAR Questionnaire demonstrated reliabilities for closeness, commitment, complementarity, and compliance of 0.87, 0.82, 0.88, and 0.93, respectively. In this study, the dimensions’ reliabilities were measured at 0.85, 0.86, 0.81, and 0.84, respectively, confirming the questionnaire’s good reliability. The overall scale score demonstrated significant correlations with two criterion items from the Greek version of the CART-Q (0.689 and 0.696), suggesting good criterion-related validity of the translated version of the questionnaire.

3.3.4 Trait hope scale

The Trait Hope Scale (THS), following the revisions by Chen et al. (2009) based on the original scale by Snyder et al. (1991) , was employed in the study. The scale comprises 12 items, such as “I can think of many ways to get out of a bind” and “I have been successful in my athletic career,” and is comprised of two dimensions: agency thinking and pathways thinking. It employs a Likert 5-point scale (1 = strongly disagree; 2 = disagree; 3 = somewhat agree; 4 = agree; 5 = strongly agree), with higher scores reflecting greater levels of hope. The confirmatory factor analysis yielded: χ 2 /df = 3.81, RMSEA = 0.076, SRMR = 0.042, GFI = 0.96, NFI = 0.94, CFI = 0.96, IFI = 0.96. The English version of the THS demonstrated reliabilities across agency and pathways thinking domains of 0.74 and 0.84, respectively. In the current study, the questionnaire exhibited an overall reliability of 0.82, with reliabilities for agency and pathways thinking at 0.69 and 0.78, respectively, and exhibited a test–retest correlation coefficient of 0.80, indicating consistency with the reliability of the English version of the Hope Scale. Validity testing revealed that agency and pathways thinking dimensions of the Hope Scale were significantly positively correlated with a proactive coping approach and significantly negatively correlated with a passive coping style, consistent with international research findings ( Woodward et al., 2006 ), indicating good criterion-related validity of the scale.

3.4 Data analysis

Data were organized, processed, and analyzed using SPSS 20.0 and AMOS 24.0 software. Beyond descriptive statistics and bivariate correlations, the study primarily employed Structural Equation Modeling (SEM) as the method of data processing, with the significance level established at α = 0.05. While these components—emotional/physical exhaustion, reduced sense of achievement, and negative sports appraisal—are facets of burnout, their distinct contributions must be considered and not aggregated. The utilization of Zhang et al.’s (2010) weighted total score formula for burnout (Burnout Weighted Total Score =  Z -score for Reduced Sense of Achievement × 0.47 +  Z -score for Emotional/Physical Exhaustion × 0.21 +  Z -score for Negative Sports Appraisal × 0.32) facilitated the derivation of the composite burnout score. These scores were additionally subjected to individual analyses for each dimension. The research not only examined the mediating roles of the CAR and hope between gratitude and the composite burnout score but also their intermediary functions between gratitude and the three discrete dimensions of burnout. These analyses elucidated the complex interplay among these variables, contributing to a deeper understanding of athlete burnout.

4.1 Control and test for common method bias

Data were collected through self-report measures in this study, which raises the potential for common method bias. To mitigate this, the administration of the measures included imposing strict procedural controls regarding the data’s confidentiality, anonymity, and exclusive use for scientific research. Furthermore, Harman’s single-factor test was applied for analytic examination ( Podsakoff et al., 2003 ; Zhou and Long, 2004 ). This method involved loading all measurement items of the study variables into a single factor to create a one-factor model and contrasting it with the fit indices of an 11-factor model that aligned with the theoretical dimensions. The results indicated that the fit indices for the 11-factor model (χ 2  = 1959.39, df = 979, χ 2 /df = 2.00, RMSEA = 0.05, CFI = 0.90, IFI = 0.90, TLI = 0.88) were significantly better than those for the single-factor model (χ 2  = 6208.24, df = 1,034, χ 2 /df = 6.00, RMSEA = 0.10, CFI = 0.44, IFI = 0.44, TLI = 0.41), which suggests that a serious common method bias is unlikely in the current study.

4.2 Correlation analysis of gratitude, CAR, hope, and burnout

As presented in Table 2 , upon controlling for demographic variables (gender, age, years of athletic participation, and level of competition), gratitude, CAR, and hope showed a significant negative correlation with burnout. Moreover, gratitude and CAR demonstrated a significant positive correlation with hope, and gratitude was significantly positively correlated with the CAR. The absolute values of the correlation coefficients among the study variables ranged between 0.32 to 0.50, indicating their appropriateness for further analysis. The mean scores for gratitude and the CAR were notably high, potentially reflecting the influence of social desirability effects, while the limited variability could be attributed to a ceiling effect.

Table 2 . Correlation coefficients among gratitude, CAR, hope, and burnout ( N  = 483).

4.3 Examination of the mediating effect of CAR and hope between gratitude and burnout

Following the recommendation of Fang et al. (2012) , the percentile Bootstrap method with bias correction offers superior statistical power compared to the traditional Sobel test. Consequently, this study employed the SPSS macro program PROCESS, developed by Hayes (2013) , 1 and controlled for demographic variables including gender, age, duration of sports participation, and level of athletic competition. Mediation effects were evaluated through a structural equation model, based on 5,000 bootstrap samples to establish 95% confidence intervals.

Preliminary results, as shown in Table 3 , indicated that gratitude maintained a significant positive influence on CAR ( β  = 0.52, p  < 0.001). When gratitude and CAR were predictors of hope, gratitude maintained a significant positive influence ( β  = 0.27, p  < 0.001), and CAR also displayed a significant positive impact ( β  = 0.19, p  < 0.001). When gratitude, CAR, and hope were introduced into the regression equation concurrently, each variable exhibited a significant negative predictive influence on burnout ( β  = −0.23, p  < 0.001; β  = −0.21, p  < 0.001; β  = −0.19, p  < 0.001), indicating a significant mediating role of CAR and hope in the relationship between gratitude and burnout.

Table 3 . Regression analysis overview for testing the mediation effects of CAR and hope between gratitude and burnout.

Furthermore, detailed scrutiny of the mediation effects, as presented in Table 4 , showed that the total indirect effects produced by CAR and hope did not include zero within the 95% Bootstrap confidence interval, indicative of a significant mediating effect by the two variables between gratitude and burnout. The mediation effect comprises three indirect effects: (1) The first, generated by the path “Gratitude → CAR → Burnout,” with the confidence interval excluding zero, indicates a significant CAR mediation between gratitude and burnout (−0.11, contributing to 26.83% of the total effect); (2) the second, generated by the path “Gratitude → Hope → Burnout,” with the confidence interval excluding zero, indicates a significant hope mediation between gratitude and burnout (−0.05, contributing to 12.20% of the total effect); and (3) the third, generated by the path “Gratitude → CAR → Hope → Burnout,” with the confidence interval excluding zero, indicates partial mediation by CAR and hope between gratitude and burnout (−0.02, contributing to 4.88% of the total effect). Based on these results, a serial mediation model as depicted in Figure 1 can be constructed, accounting for 25% of the variance in burnout.

Table 4 . Overview of bootstrap analysis for the mediating effects of CAR and hope between gratitude and burnout.

Figure 1 . Mediation model of CAR and hope between gratitude and burnout. Solid lines indicate significant paths; dashed lines indicate non-significant paths.

5 Discussion

This study investigated the association between athlete gratitude and burnout, considering the perspectives of CARs and hope, and the mechanisms underlying this relationship. The findings indicate a significant negative correlation between athlete gratitude and burnout, with additional regression analysis demonstrating that athlete gratitude significantly predicts lower levels of burnout, thereby supporting Hypothesis H1. Athlete gratitude was also identified as being significantly positively correlated with the CAR; subsequently, a strong CAR was observed to significantly predict lower burnout, thus confirming Hypothesis H2. The mediation analysis revealed that the CAR and hope mediate the influence of athlete gratitude on burnout. This mediation effect unfolded via two pathways: the independent mediating role of hope and the sequential mediating effect of the CAR to hope, thereby validating Hypotheses H3 and H4. In summary, all four hypotheses proposed in this study have been corroborated by empirical evidence.

5.1 The direct effects of gratitude on burnout

Gratitude, recognized as a positive and affirming emotion, can broaden an individual’s scope of thought and action. Individuals who habitually practice gratitude tend to focus on the positive and pleasant aspects of life, enhancing their ability to recover from the negative effects of adverse events ( Fredrickson, 2004 ). According to gratitude coping theory, those with a strong propensity for gratitude are more likely to engage in positive coping strategies when faced with challenging or risky situations ( Fredrickson and Cohn, 2008 ). These individuals view everything they have, including life itself, as a gift, meeting life’s challenges with heightened positivity and optimism, which facilitates better social adaptation and well-being ( Wood et al., 2007 , 2008 , 2009 ).

In the context of sports, gratitude can broaden athletes’ cognitive and behavioral patterns, bolster personal resources, and provide the essential material and psychological support necessary to strengthen resilience against setbacks and diminish the negative impact of distressing emotions. This enhancement of psychological well-being contributes to the prevention of burnout. Empirical evidence suggests that athletes’ gratitude leads to greater investment in their sport and adherence to ethical behavior, thereby fostering improved engagement in training and competition, superior performance, and recognition from coaches and peers ( Wang et al., 2014 ; Ye, 2016 ). Additionally, athletes with a pronounced sense of gratitude are more apt to attribute their successes to the collective efforts of their support networks, including their country, family, coaches, and teammates. Confronted with competitive stress or the adversities of life, such athletes typically embrace an optimistic and proactive approach, successfully circumventing negative appraisals in sports.

5.2 The mediating effects of the CAR and hope on the relationship between gratitude and burnout

In the nexus of interpersonal dynamics, the Coach-Athlete Relationship (CAR) acts as a critical bridge. Gratitude fosters the development of a harmonious CAR, which is instrumental in building and sustaining social bonds. The expansive cognitive and behavioral effects of gratitude facilitate the creation and preservation of positive social connections, thereby attracting enhanced social support ( Fredrickson, 2004 ; Fredrickson and Branigan, 2005 ; Wood et al., 2009 ). In the domain of sports, athletes who possess a strong propensity for gratitude can adopt their coaches’ perspectives during crises within the CAR, acknowledging the coaches’ sincere efforts and dedicating themselves to repairing any rifts ( Gan, 2012 ). This propensity toward gratitude also influences coaches, who respond with proactive prosocial behaviors, nurturing the growth of a harmonious rapport. Additionally, the CAR has been shown to inversely predict burnout, with harmonious interactions enabling athletes to maintain robust relationships and emotional connections with coaches, thus mitigating undue interpersonal stress and curbing the onset of burnout symptoms ( Jowett, 2009 ; Adie and Jowett, 2010 ; Tabei et al., 2012 ).

Hope, as elucidated by the broaden-and-build theory, serves as a mediator in the gratitude-burnout relationship. Individuals with a strong disposition toward gratitude are likely to perceive the world more positively and proactively expand their cognitive horizons with an inclusive mindset, thereby effectively managing stress ( Fredrickson, 2004 ; Fredrickson and Branigan, 2005 ). Research by Chen and Chi (2012 , 2015) corroborates that hope and self-confidence are significantly tied to enhanced athletic performance, suggesting that elevated levels of these attributes in college athletes correlate with superior performance outcomes. An augmentation in hope allows individuals to sustain agency and pathways thinking, essential when confronting challenges or stress, safeguarding against negative affectivity and thus forestalling or lessening burnout ( Gustafsson et al., 2010 ). Consequently, psychological interventions targeting burnout could potentially be optimized by concentrating on elevating hope levels, which may improve athletic performance while simultaneously mitigating burnout risks.

5.3 The sequential mediating effects of CAR and hope on the relationship between gratitude and burnout

McCullough et al. (2002) contend that gratitude, conceptualized as a moral emotion, serves as a vital cohesive force within social collectives. Within the context of coach-athlete dyads, a harmonious CAR promotes positive and efficacious interactions that alleviate interpersonal tensions, thereby fortifying athletes’ sense of self-identity, clarifying their motivational direction, and amplifying their satisfaction derived from athletic endeavors. This environment is conducive to fostering a hopeful disposition, an optimistic state that buffers against adverse feelings and behaviors ( Tennen et al., 2009 ; Jowett and Nezlek, 2012 ; Ye et al., 2016a , b ). Gustafsson et al. (2010) further reveal that hope robustly negates the propensity for athlete burnout. The present study indicates that athletes endowed with elevated hope are adept at navigating adversities, utilizing optimal strategies to surmount challenges, and maintaining heightened motivation. Hope is instrumental not only in facilitating success when free from impediments but also in proactively addressing and ameliorating psychological distress in response to stressors and adversities, thereby diminishing manifestations of athlete burnout. In summation, both CAR and hope constitute integral components of a ‘mediatory chain’ that links gratitude to athlete burnout, delineating a complex interplay of psychological constructs that underlie the well-being of athletes.

5.4 Limitations and future research

This study adopts a cross-sectional design, constraining the extent to which causal relationships can be inferred among the examined variables. Recognizing that athlete burnout fluctuates over time, as suggested by Gustafsson et al. (2010) , longitudinal research could offer a more nuanced understanding of its progression. The analysis of the CAR in this study is limited to athletes’ self-reports, omitting coaches’ perspectives, which may provide a more comprehensive overview of the CAR dynamic. Consequently, future studies should consider incorporating matched reports from both coaches and athletes to enrich the understanding of CAR. Methodologically, while the current study constructs a mediation model exploring the interp r mediating roles in the gratitude-burnout nexus, future studies may delve deeper into how gender and sports performance influence these relationships. Our preliminary analyses indicate that these factors might significantly affect the psychological state of athletes. In particular, further research could explore the relationship between technical level and athlete burnout and consider how this relationship may evolve over time.

6 Conclusion

The research findings indicate that gratitude, CAR, and hope are integral in attenuating athlete burnout, serving as potent negative predictors. The sequential mediation model elucidated herein demonstrates that gratitude impacts athlete burnout indirectly through CAR and hope, both individually and in combination. These insights provide a theoretical foundation and practical framework for creating interventions aimed at diminishing athlete burnout. To optimize future intervention strategies, enhancing athletes’ gratitude levels, nurturing harmonious CAR, and fostering hope are pivotal. Such measures could not only mitigate the incidence of burnout but also enrich the overall psychological resilience of athletes, thereby contributing to their well-being and performance longevity.

Data availability statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.

Ethics statement

The studies involving humans were approved by China University of Geosciences. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

Author contributions

LD: Writing – original draft, Writing – review & editing. RF: Formal analysis, Methodology, Project administration, Supervision, Writing – review & editing. SZ: Supervision, Writing – review & editing. BW: Project administration, Writing – review & editing. LY: Project administration, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This project is supported by the National Natural Science Foundation of China (Youth Project No. 62307034), the Key Project of National Social Science Foundation of China (23FTYA005), the Hubei Provincial Natural Science Foundation (Youth Project No. 2023AFB359), and the Youth Foundation of Humanities and Social Science Research of the Ministry of Education of China (No. 22YJC890005).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. ^ http://www.afhayes.com

Adie, J. W., and Jowett, S. (2010). Meta-perceptions of the coach–athlete relationship, achievement goals, and intrinsic motivation among sport participants. J. Appl. Soc. Psychol. 40, 2750–2773. doi: 10.1111/j.1559-1816.2010.00679.x

Crossref Full Text | Google Scholar

Algoe, S. B., Haidt, J., and Gable, S. L. (2008). Beyond reciprocity: gratitude and relationships in everyday life. Emotion 8, 425–429. doi: 10.1037/1528-3542.8.3.425

PubMed Abstract | Crossref Full Text | Google Scholar

Algoe, S. B., and Stanton, A. L. (2012). Gratitude when it is needed most: social functions of gratitude in women with metastatic breast cancer. Emotion 12, 163–168. doi: 10.1037/a0024024

Chen, C.-W., and Chi, L.-K. (2012). Prediction of Hope, confidence, and goal orientations on sports performance among college students. Sports Exerc. Res. 14, 73–81. doi: 10.5297/ser.1401.008

Chen, C.-W., and Chi, L.-K. (2015). The application of hope theory in sport psychology. Bull. Sport Exerc. Psychol. Taiwan 15, 75–94. doi: 10.6497/BSEPT2015.1501.04

Chen, L. H., Chen, M. Y., Kee, Y. H., and Tsai, Y. M. (2009). Validation of the gratitude questionnaire (GQ) in Taiwanese undergraduate students. J. Happiness Stud. 10, 655–664. doi: 10.1007/s10902-008-9112-7

Chen, L. H., and Kee, Y. H. (2008). Gratitude and adolescent athletes’ well-being. Soc. Indic. Res. 89, 361–373. doi: 10.1007/s11205-008-9237-4

Cresswell, S. L., and Eklund, R. C. (2005). Motivation and burnout among top amateur rugby players. Med. Sci. Sports Exerc. 37, 469–477. doi: 10.1249/01.MSS.0000155398.71387.C2

Defreese, J. D., and Smith, A. L. (2014). Athlete social support, negative social interactions, and psychological health across a competitive sport season. J. Sport Exerc. Psychol. 36, 619–630. doi: 10.1123/jsep.2014-0040

Fang, J., Zhang, M.-Q., and Chiou, H.-J. (2012). Mediation analysis and effect size measurement: retrospect and prospect. Psychol. Dev. Educ. 28, 105–111.

Google Scholar

Fredrickson, B. L., and Branigan, C. (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognit. Emot. 19, 313–332. doi: 10.1080/02699930441000238

Fredrickson, B. L., and Cohn, M. A. (2008). “Positive emotions” in Handbook of emotions . eds. M. Lewis, J. M. Haviland-Jones, and L. F. Barrett (New York: Guilford Press), 777–796. doi: 10.1093/acprof:oso/9780195150100.003.0008

Fredrickson, B. L. (2004). “Gratitude, like other positive emotions, broadens and builds” in The psychology of gratitude . eds. R. A. Emmons and M. E. McCullough (New York, NY: Oxford University Press), 145–166.

Froh, J. J., Yurkewicz, C., and Kashdan, T. B. (2009). Gratitude and subjective well-being in early adolescence: examining gender differences. J. Adolesc. 32, 633–650. doi: 10.1016/j.adolescence.2008.06.006

Gan, Q.-Y. (2012). A research on the relationship between gratitude and interpersonal relation. Sci. Soc. Psychol. 9, 69–73.

Gustafsson, H., DeFreese, J., and Madigan, D. (2017). Athlete burnout: Review and recommendations. Current Opinion in Psychology , 16, 109–113. doi: 10.1016/j.copsyc.2017.05.002

Gustafsson, H., Hassmén, P., and Podlog, L. (2010). Exploring the relationship between hope and burnout in competitive sport. J. Sports Sci. 28, 1495–1504. doi: 10.1080/02640414.2010.521943

Gustafsson, H., Kenttä, G., and Hassmén, P. (2011). Athlete burnout: an integrated model and future research directions. Int. Rev. Sport Exerc. Psychol. 4, 3–24. doi: 10.1080/1750984X.2010.541927

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach . New York, NY: The Guilford Press.

Hu, L. T., and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct. Equ. Model. Multidiscip. J. 6, 1–55. doi: 10.1080/10705519909540118

Isoard-Gautheur, S., Trouilloud, D., Gustafsson, H., and Guillet-Descas, E. (2016). Associations between the perceived quality of the coach–athlete relationship and athlete burnout: An examination of the mediating role of achievement goals. Psychology of Sport and Exercise , 22, 210–217. doi: 10.1016/J.PSYCHSPORT.2015.08.003

Johnson, J., Gooding, P. A., Wood, A. M., and Tarrier, N. (2010). Resilience as positive coping appraisals: testing the schematic appraisals model of suicide (SAMS). Behav. Res. Ther. 48, 179–186. doi: 10.1016/j.brat.2009.10.007

Jowett, S. (2009). Factor structure and criterion-related validity of the metaperspective version of the coach–athlete relationship questionnaire (CART-Q). Group Dyn. Theory Res. Pract. 13, 163–177. doi: 10.1037/a0014998

Jowett, S., and Nezlek, J. (2012). Relationship interdependence and satisfaction with important outcomes in coach-athlete dyads. J. Soc. Pers. Relat. 29, 287–301. doi: 10.1177/0265407511420980

Jowett, S., and Ntoumanis, N. (2004). The coach–athlete relationship questionnaire (CART-Q): development and initial validation. Scand. J. Med. Sci. Sports 14, 245–257. doi: 10.1111/j.1600-0838.2003.00338.x

Liang, L., Hou, Z., and Qi, L. (2015). Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: direct, mediated, and moderated effects. J. Adolesc. 39, 59–69. doi: 10.1016/j.adolescence.2014.12.008

Lu, J. H., Chen, L. H., and Cho, K. H. (2006). Revision of Raedeke and Smith’s athlete burnout questionnaire (ABQ): analyses of validity and reliability of Chinese version. Physic. Educ. J. 39, 83–94. doi: 10.6222/pej.3903.200609.1107

McCullough, M. E., Emmons, R. A., and Tsang, J.-A. (2002). The grateful disposition: a conceptual and empirical topography. J. Pers. Soc. Psychol. 82, 112–127. doi: 10.1037/0022-3514.82.1.112

McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., and Larson, D. B. (2001). Is gratitude a moral affect? Psychol. Bull. 127, 249–266. doi: 10.1037/0033-2909.127.2.249

Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., and Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. J. Appl. Psychol. 88, 879–903. doi: 10.1037/0021-9010.88.5.879

Raedeke, T. D., and Smith, A. L. (2001). Development and preliminary validation of an athlete burnout measure. J. Sport Exerc. Psychol. 23, 281–306. doi: 10.1123/jsep.23.4.281

Smith, R. E. (1986). Toward a cognitive-affective model of athletic burnout. J. Sport Psychol. 8, 36–50. doi: 10.1123/jsp.8.1.36

Snyder, C. R. (Ed.). (2000). Handbook of Hope . New York: Academic Press.

Snyder, C. R. (2002). Hope theory: rainbows in the mind. Psychol. Inq. 13, 249–275. doi: 10.1207/S15327965PLI1304_01

Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., et al. (1991). The will and the ways: development and validation of an individual-differences measure of hope. J. Pers. Soc. Psychol. 60, 570–585. doi: 10.1037/0022-3514.60.4.570

Sun, G., and Zhang, L. (2013). Effect of self-determined motivation on athlete burnout: evidence from cross-sectional and longitudinal study. China Sport Sci. 33, 21–28. doi: 10.3969/j.issn.1000-677X.2013.07.003

Tabei, Y., Fletcher, D., and Goodger, K. (2012). The relationship between organizational stressors and athlete burnout in soccer players. J. Clin. Sport Psychol. 6, 146–165. doi: 10.1123/jcsp.6.2.146

Tennen, H., Cloutier, M. M., Wakefield, D. B., Hall, C. B., and Brazil, K. (2009). The buffering effect of hope on clinicians' behavior: a test in pediatrics. J. Soc. Clin. Psychol. 28, 554–576. doi: 10.1521/jscp.2009.28.5.554

Wang, B., Ye, L., Wu, M., Feng, T., and Peng, X. (2014). Effects of gratitude on athlete engagement: mediation of coach-athlete relationship. J. Beijing Sport Univ. 37, 85–90. doi: 10.19582/j.cnki.11-3785/g8.2014.09.014

Wood, A. M., Joseph, S., and Linley, P. A. (2007). Coping style as a psychological resource of grateful people. J. Soc. Clin. Psychol. 26, 1076–1093. doi: 10.1521/jscp.2007.26.9.1076

Wood, A. M., Joseph, S., Lloyd, J., and Atkins, S. (2009). Gratitude influences sleep through the mechanism of pre-sleep cognitions. J. Psychosom. Res. 66, 43–48. doi: 10.1016/j.jpsychores.2008.09.002

Wood, A. M., Maltby, J., Stewart, N., Linley, P. A., and Joseph, S. (2008). A social-cognitive model of trait and state levels of gratitude. Emotion 8, 281–290. doi: 10.1037/1528-3542.8.2.281

Woodward, J. T., Feldman, D. B., and Cheavens, J. S. (2006). Hope in cognitive psychotherapies: on working with client strengths. J. Cogn. Psychother. 20, 135–145. doi: 10.1891/jcop.20.2.135

Xie, D., Zhao, Z., Duan, W., and Hu, W. (2016). The application, characteristic, and inspiration of hopeful thinking in the clinical area. J. Psychol. Sci. 3, 741–747. doi: 10.16719/j.cnki.1671-6981.20160334

Ye, L., Wang, B., and Liu, Z. (2016a). The effect of coach-athlete relationship on sport performance satisfaction: serial multiple mediating effect of hope and athlete engagement. China Sport Sci. 36, 40–48. doi: 10.16469/j.css.201607005

Ye, L., Wang, B., and Ma, H. (2016b). Concept, theoretical models, and research prospects of athlete burnout. J. Chengdu Sport Univ. 42, 83–88. doi: 10.15942/j.jcsu.2016.01.016

Ye, N. (2016). Effect of ethical coaching on Athletes' sportsmanship: a moderated mediation model. J. Wuhan Institute Physic. Educ. 50, 66–69. doi: 10.15930/j.cnki.wtxb.2016.11.010

Zhang, L. (2010). Seven directions of psychological research: taking exercise-induced mental fatigue as an example. China Sport Sci. 30, 3–12. doi: 10.3969/j.issn.1000-677X.2010.10.001

Zhang, L., Lin, L., and Zhao, F. (2006). The nature, causes, diagnosis, and control of exercise mental fatigue. China Sport Sci. 26, 49–56. doi: 10.3969/j.issn.1000-677X.2006.11.008

Zhang, L., Li, S., and Liu, Y. (2014). A review of the progress made in theoretical researches on kinetic mental fatigue. J. Phys. Educ. 1, 98–103. doi: 10.16237/j.cnki.cn44-1404/g8.2014.01.024

Zhang, L. W., and Mao, Z. X. (2010). Manual for commonly used psychological scales in sports science (2nd ed.). Beijing: Beijing Sport University Press.

Zhong, R.-S., and Wang, D. (2007). A cross-culture validity of coach-athlete relationship questionnaire. J. Wuhan Institute Physic. Educ. 41, 36–39. doi: 10.3969/j.issn.1000-520X.2007.04.008

Zhou, H., and Long, L. (2004). Statistical remedies for common method biases. Adv. Psychol. Sci. 12, 942–950. doi: 10.3969/j.issn.1671-3710.2004.06.018

Keywords: athlete burnout, gratitude, coach–athlete relationship, hope, positive psychology

Citation: Dong L, Zou S, Fan R, Wang B and Ye L (2024) The influence of athletes’ gratitude on burnout: the sequential mediating roles of the coach–athlete relationship and hope. Front. Psychol . 15:1358799. doi: 10.3389/fpsyg.2024.1358799

Received: 20 December 2023; Accepted: 04 April 2024; Published: 24 April 2024.

Reviewed by:

Copyright © 2024 Dong, Zou, Fan, Wang and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Rong Fan, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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The Fascinating History of Burnout

ARIANNA HUFFINGTON

Years before the coronavirus pandemic started, the world was already   experiencing an epidemic of burnout. And the phenomenon has only gotten worse as the pandemic has progressed. Not surprisingly, rising rates of burnout were first felt by  doctors ,  nurses  and other frontline  healthcare workers . Soon, the conversation expanded to include those  working from home  as well as frontline workers in a range of service industries, from grocery store cashiers and factory workers to mail carriers and bus drivers.

To better understand our own experience of burnout during the pandemic, we can look back nearly 50 years to the moment when the modern idea of burnout originated.   The concept was developed in the mid-1970s by two researchers working independently, psychoanalyst   Herbert Freudenberger, and  Christina Maslach , a professor of psychology at the University of California, Berkeley.

Freudenberger is credited with coining the term, or at least bringing it into modern usage. In the 1970s he was working at a free substance abuse clinic in New York City. He was putting in punishing hours, as were others at the clinic, some of whom quit, suffering what Pascal Chabot, in his book  Global Burnout , describes as nervous breakdowns. Finally, Freudenberger agreed to take a vacation with his family. Working late the night before their departure, he couldn’t get out of bed the next morning and they missed their flight. Trying to make sense of the experience, he recorded himself talking about it, and when he played the tape back, he was taken aback by the anger and exhaustion he could hear in his voice.

He decided to look into the mental well-being of the other caregivers at the clinic, and he was struck by how many parallels there were between them and the addicts they were caring for. At the time, the term “burnout” was a slang term to describe extreme drug use, but when Freudenberger started using it for those working at the clinic, they promptly took it up. “The caregivers had been ravaged by forces as toxic as the drugs their patients abused: They were overworked, perhaps overly idealistic, and certainly overly committed,” Chabot writes. “Like substance abuse, burnout is an illness of immoderation.”

The term “burnout” also has origins in the effects of a fire as Freudenberger vividly put it: “As a practicing psychoanalyst, I have come to realise that people, as well as buildings, sometimes burn out. Under the strain of living in our complex world, their inner resources are consumed as if by fire, leaving a great emptiness inside, although their outer shells may be more or less unchanged… Only if you venture inside will you be struck by the full force of the desolation.”

Meanwhile, at about the same time, and on the opposite coast, Christina Maslach had just gotten her Ph.D., studying how people respond to crises, and was starting her research career at Berkeley. She began by interviewing people in service sectors, including   healthcare workers, but also police officers and ministers, and she started to notice   common themes. She began asking if the term burnout described their experience. What she  found  was that it was more than just a psychological concept: “The people themselves said this term captured what they were feeling.”

When she decided to publish her research she had difficulty finding a publisher, with science journal   editors dismissing the idea as mere popular science and not worthy of academic journals. So in 1976 she published it in a magazine called  Human Behavior .  The result? She was flooded with responses. “People would say, ‘Oh my gosh. I thought I was the only one. Let me tell you my story.’”

That’s how she stumbled on what would become her career. “My interest in the topic really was stoked by the experiences of the people that I kept talking to over time, and that’s true even now,” she  said . “I’d be interviewing people, and they were getting angry and upset and crying. This was not something trivial. People tell me stories about how this has affected their family and how they’ve made decisions they now wish they hadn’t.”

Along with  Susan E. Jackson , now a professor at Rutgers, she developed the  Maslach Burnout Inventory (MBI) , a widely used framework for identifying and measuring burnout. The tool  breaks burnout  down into three dimensions of exhaustion, cynicism and negative self-worth, and six workplace risk categories: workload, sense of control, reward, workplace relationships, fairness and values alignment. The Maslach Burnout Inventory was also the framework the World Health Organization used last year when it  added burnout  to its  International Classification of Diseases and Related Health Problems .

Of course, in some form, burnout has always been with us. But the pandemic has intensified it exponentially. Starting back in March, in cities and communities all over the world, we expressed our appreciation for frontline workers of all kinds — whether they were working in hospitals or grocery stores, or making sure those working remotely could get food and household supplies dropped at their door. They were putting themselves at risk not just of infection, but of burnout, which hit them hard in the first wave of the pandemic. And soon burnout was at the center of the conversation among frontline workers,  and  among those of us working at home, staring at screens all day and trying to create boundaries between our work lives and our home lives.

So much of our lives right now is out of our control. That’s why it’s even more important to be deliberate about employing tools and strategies in our daily lives to manage our stress and avoid burnout. At Thrive we call these strategies Microsteps — they’re science-backed steps that we can incorporate into our lives right away. We have hundreds of them and they’re too small to fail! Here are five Microsteps to take with you into this month that will assist with less stress, more calm and no burnout.

When you wake up, don’t start your day by looking at your phone.  Take one minute to focus on your intention for the day or remember what you’re grateful for or simply take some conscious breaths.

Practice box breathing in moments of stress.  This technique, practiced by the Navy SEALS, is a powerful stress reliever that works by activating our parasympathetic nervous system, which lowers our stress. Just inhale for a count of four, hold the air in your lungs full for a count of four, then exhale for a count of four.

Set a news cut-off time at the end of the day.  While being informed can help us feel more prepared in the middle of a public health crisis, setting healthy limits to our media consumption can help us have a recharging night’s sleep and put the stressful news into perspective.

Right now, send a message to a neighbor or friend and ask how you can help them.  Reaching out to others puts our stresses and worries into perspective, and gives us a much needed “helper’s high” that boosts our well-being.

Declare an end to the working day.  The truth is that our working day never ends so we need to declare an end. And mark it by turning off our phone and ideally charging it outside of our bedroom.

Subscribe  here  for Arianna’s On My Mind Newsletter, where you’ll find inspiration and actionable advice on how to build healthy habits, resilience and connections in our unprecedented times.

— Published on December 11, 2020

Arianna Huffington, Thrive Global Founder & CEO

Arianna Huffington is the founder and CEO of Thrive Global, the founder of The Huffington Post, and the author of 15 books, including, most recently, Thrive  and  The Sleep Revolution . In 2016, she launched Thrive Global, a leading behavior change tech company with the mission of changing the way we work and live by ending the collective delusion that burnout is the price we must pay for success.

She has been named to Time Magazine’s list of the world’s 100 most influential people and the Forbes Most Powerful Women list. Originally from Greece, she moved to England when she was 16 and graduated from Cambridge University with an M.A. in economics. At 21, she became president of the famed debating society, the Cambridge Union.

She serves on numerous boards, including Onex and The B Team.

Her last two books,  Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, and Wonder  and  The Sleep  Revolution: Transforming Your Life, One Night At A Time , both became instant international bestsellers.

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When Meaningful Work Backfires

I t’s easy to let high stress steal our full attention. Often, high stress leaves us vulnerable to a dysregulated, unproductive state. This means we need reliable resources we can connect to in order to renew and maintain our mental, emotional, and physical energy, and to help us recover from work stressors that, left unchecked, can make us vulnerable to burnout.

As a burnout researcher, my work has been focused on pinpointing the most reliable and effective resources people can connect to in order to protect themselves from burnout . I’ve conducted hundreds of in-depth interviews with people who experience high stress at work, but they are not burned out. From my research, I found that those who have a deep, lasting connection with their purpose and a sense that they are engaged in meaningful work are significantly less vulnerable to burnout. Yet, while having a high level of engagement with your work can protect you from burnout, being over-engaged in meaningful work can come with some potential risks.

In fact, some of the people who are at the highest risk of burnout are those who genuinely love their work and who routinely go the extra mile. This is certainly no guarantee of developing burnout, but it’s very important to be aware of the hidden downsides of devoting yourself to meaningful work and to the ways it can potentially backfire.

Perhaps the most common way is that your work life simply becomes unsustainable. Whether it’s the relentless pace, the emotional or mental intensity, the long work hours, or a scary combination of all three, becoming subsumed in your job without sufficient time to recharge can put you on the fast track to burnout.

Read More: Why We’re More Exhausted Than Ever

Researchers have noted a particular vulnerability to burnout in those in the “helping” professions, such as health care workers , social workers, clergy members, counselors, life coaches, and direct care providers. These professionals tend to be deeply purpose-driven and often prioritize the needs of others over their own. Many of them are also vulnerable to a related phenomenon known as empathic distress, a strong aversive response to others’ pain and suffering that arises when you spend a lot of time caring for those who are suffering. Empathic distress leads people to withdraw in an effort to protect themselves, resulting in avoidance, cynicism, and reduced motivation—some of the very same signs of burnout. Much the same vulnerability to burnout exists in individuals who are deeply mission-driven and who prioritize their organization’s needs and goals over their own. Educators, activists, and nonprofit employees are great examples, as are startup founders, entrepreneurs, small-business owners, and changemakers and disruptors of all stripes.

Take, for instance, Jenn Richey Nicholas, who was working for a top-tier graphic design firm on a very high-profile project that would be seen around the world. She had dreamed of being a graphic designer ever since she was in middle school and always loved the idea of being on a highly talented team where Richey Nicholas and her colleagues shared a passion for design. The firm’s reputation was riding on this project, and it had the potential to be career-defining for the entire team. Everyone was expected to work 120 hours a week or more; many people resorted to sleeping under conference tables and would only go home to shower. Richey Nicholas described how “people were dropping like flies from exhaustion,” and after one colleague passed out several times, he had to be admitted to the ER. “I was terrified I’d be ruined in the industry if I took a break,” she told me. “Fear was the only thing keeping me there.”

After months of this grueling schedule where Richey Nicholas pushed herself to her physical and mental limits, everything came to a head one day when she went to the rooftop of her office building, stood at the ledge, and thought about jumping. “I just wanted the pain to be over,” Richey Nicholas said. Her vision blurred as she stood there, and she doesn’t remember much more of the episode, except that someone took her back to the office. Incredibly, she managed to go back to work and finish the project. “Walking away was not an option,” she said. When it was finally over, she went home and slept for two weeks.

Shortly thereafter, she went to London to visit a friend who was also a graphic designer. Richey Nicholas was astonished to see that her friend and her team were working from nine to five—and her friend was astonished to hear what she had just been through. “I gained a lot of perspective on the toxicity I’d been wrapped up in,” she said. “That experience made me lose my sense of self. I felt like my body wasn’t even mine.”

But now she was awake and aware, and she wasn’t going back. “Since then,” Richey Nicholas told me, “I have built myself and my work ethic around never doing that again.” She left that firm and worked as a designer at other firms for a few years, while dreaming about launching her own business. Today she runs a successful graphic design firm committed to making a positive social and environmental impact in the world, and where mental health and overall well-being are priorities. “We rarely work more than 40 hours a week,” Richey Nicholas said. “We want to be a model for other studios. Our hope is that, one by one, firms like ours will gradually change the toxic culture of this industry.”

When you love your work and consider it a calling, or if you’re exceptionally purpose-driven and committed, your job will demand a lot of you. You can often find yourself overextended, because you’re so passionate about your cause and care so deeply about improving others’ lives, or you’re overcommitted to your organization’s mission or goals. But without sufficient periods to rest and recharge, the risk is high for exhaustion, depersonalization, and, down the line, a lack of efficacy, as you become increasingly overwhelmed and depleted.

When work becomes the central focus of our lives (for any reason)—or when our identity gets excessively wrapped up in what we do for a living—we run the risk of making too many personal sacrifices and losing sight of our own self-care, leaving us ripe for burnout.

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Do workers with a recent history of burnout make different career choices?

by Ghent University

Previous research showed that clinical burnout complicates career resumption because employers are less inclined to hire or promote previously burned-out workers. Researchers Philippe Sterkens, Stijn Baert, Eline Moens, Joey Wuyts and Eva Derous now studied the opposite perspective: Do workers with a recent history of burnout make different career choices?

To answer this question, the interdisciplinary research team had a representative sample of Belgian workers participate in an experiment in which they evaluated fictitious job offers with varying characteristics. The results are published in the Journal of Population Economics .

From their experiment, we learn that workers with a recent history of clinical burnout were relatively more attracted to jobs in which there were more telecommuting opportunities and feedback was provided regularly. Surprisingly, they also valued jobs with training opportunities less than workers without a recent history of clinical burnout.

"From previous research we know that burnout can be explained by excessive work demands and too limited resources that can buffer these demands (such as appreciation in the workplace). Our recent analyses now indicate that job demands and resources are similarly important in explaining the career choices made by individuals who experienced burnout.

"Specifically, feedback opportunities are perceived more strongly as a job resource by workers who recently experienced clinical burnout," says Philippe Sterkens, doctoral researcher in economics and psychology.

These findings are consistent with previous research among formerly burned-out workers showing that supervisor support is a crucial determinant of a successful return to work.

Policy perspectives

The researchers link the following policy advice to their study results.

"First, it appears that job crafting is a valuable instrument for workers with a history of burnout who are looking for sustainable re-employment. Arranging opportunities for feedback would be an example of a potent job crafting intervention," says Philippe Sterkens, doctoral researcher in economics and psychology.

"Second, following up on and encouraging the professional training of burned-out workers remains crucial because learning opportunities are positively related to mental health outcomes. All this, of course, within the constraints of recovery requirements."

Provided by Ghent University

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Rise and grind working late, volatile hours may lead to depression, illness by 50.

Ronnie Cohen

Working late nights and variable schedules when you're young is linked with poor health and depression at 50, a new study finds. simonkr/Getty Images hide caption

Working late nights and variable schedules when you're young is linked with poor health and depression at 50, a new study finds.

Feeling burned out and looking for reasons to work less? A new study shows that working nights and volatile schedules in young adulthood can leave you vulnerable to depression and poor health in middle age.

The research examined the work schedules and sleep patterns of more than 7,000 Americans interviewed over three decades, from the ages of 22 through 50. To the surprise of the study's author, NYU Silver School of Social Work professor Wen-Jui Han , only one-quarter of the participants worked exclusively traditional daytime hours.

The remainder – three-quarters of the sample of American workers born in the 1960s – worked variable hours. Those with more volatile work schedules, including night hours and rotating shifts, reported less sleep and a greater likelihood of poor health and depression at age 50 than those with more stable schedules and daytime hours.

"Our work now is making us sick and poor," Han said in a Zoom interview. "Work is supposed to allow us to accumulate resources. But, for a lot of people, their work doesn't allow them to do so. They actually become more and more miserable over time."

Han would like her research — published last week in PLOS One — to prompt conversations about ways to "provide resources to support people to have a happy and healthy life when they're physically exhausted and emotionally drained because of their work."

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Want to stress less in 2024 a new book offers '5 resets' to tame toxic stress.

She was one of those employees. In her 40s, when Han was up for tenure, she worked 16-hour days, taking time off only to eat and sleep, though not sleeping nearly enough. Her doctor warned her that her physical condition appeared more like that of a woman in her 60s.

She was overworking like many young professionals who have embraced hustle culture and work around the clock.

"We can say they voluntarily want to work long hours, but in reality, it's not about voluntarily working long hours," Han said. "They sense that the culture of their work demands that they work long hours, or they may get penalized."

She says the participants in her study who sacrificed sleep to earn a living, suffered depression and poor health, she said. "When our work becomes a daily stressor, these are the kind of health consequences you may expect to see 30 years down the road."

Black men and women and workers with limited educations disproportionately shouldered the burden of night shifts, volatile work schedules and sleep deprivation, the study shows.

White college-educated women with stable daytime work reported an average of six more hours of sleep a week than Black men who had not completed high school and who worked variable hours for most of their lives, Han's study found.

And Black women who did not complete high school and switched from regular daytime hours to volatile employment in their 30s were four times more likely to report poor health than white college-educated men with stable and standard daytime work lives.

The study shows a relationship between working nights and rotating shifts with poor sleep and poor health, but it cannot prove one caused the other. That said, the U.S. Centers for Disease Control and Prevention links insufficient sleep with chronic diseases, such as diabetes, heart disease and obesity, and African Americans are more likely than whites to suffer from these diseases.

How much a person needs to sleep to remain healthy depends upon age, but the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults between 18 and 60 years old get at least seven hours of shut-eye a night.

Dr. Alyson Myers appreciated the new study's focus on the connection between work schedules, sleep and poor health.

The study findings confirmed what she sees in many of her diabetes patients, who often get no more than five hours of sleep after they work night shifts. She counsels them to try to switch to days, and when they do, their health improves, the endocrinologist and professor at the Albert Einstein College of Medicine said.

Prior research has shown that sleep, diet and social habits required to work nights and rotating shifts, can increase the risk of developing diabetes. In 2019, Blacks were twice as likely as whites to die of diabetes , according to the U.S. Department of Health and Human Services.

"Poor sleep is a risk factor for diabetes that very often we do not talk about," said Myers, who was not involved in the study. "One of the things that I have to preach to my patients about is that working nights, and if you get only four or five or less hours of sleep, that's going to increase your risk of diabetes and also worsen your glycemic control."

One patient was angry with her when he followed her advice, switched from working nights to days and as a result had to contend with commute traffic. "But," she said in a Zoom interview, "we actually got better control of his blood sugar when he switched to working the day shift."

About 16% of American workers were employed outside of daytime hours in 2019, according to the U.S. Bureau of Labor Statistics.

Many of the participants in Hans' study who had volatile work schedules tended to have part-time jobs, in some cases multiple part-time jobs. "Unfortunately," Myers said, "the trend for a lot of these people is that they have to work more than one job to survive."

Ronnie Cohen is a San Francisco Bay Area journalist focused on health and social justice issues.

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New survey finds loneliness epidemic runs deep among parents

Majority of respondents feel isolation, loneliness and burnout from demands of parenthood

A new national survey conducted by The Ohio State University Wexner Medical Center finds a broad majority of parents experience isolation, loneliness and burnout from the demands of parenthood, with many feeling a lack of support in fulfilling that role.

The survey of parents conducted this month found:

• About two-thirds (66%) felt the demands of parenthood sometimes or frequently feel isolating and lonely .     
• About 62% feel burned out by their responsibilities as a parent .     
• Nearly 2 in 5 (38%) feel they have no one to support them in their parenting role .     
• Nearly 4 in 5 (79%) would value a way to connect with other parents outside of work and home.

“I work from home full time and I actually have a job where I'm on camera a lot and I'm Zoom calling people very often,” said Anne Helms, a mother of two young children in Columbus, Ohio. “However, you don't get the small talk, so you don't get the, ‘How are your children? How's it going?’ And you don't get a lot of genuine answers when you do ask, ‘How is it going?’

“There are some days where the most chit-chat or idle talk that I get is with my dog because I work alone.”

“It's pretty obvious that there is a huge difference between a virtual meeting and being in person,” said Kate Gawlik , DNP, associate clinical professor at The Ohio State University College of Nursing, a researcher on parental burnout and a mother of four young children. “You miss a lot of those small interactions that you'd have in the hallway. Just a lot more of that personal touch has been eliminated, and in many regards it's just never been infiltrated back into our society.”

“Even the places that I do try and seek out other parents, it's kind of like we're lost in the shuffle because it's at daycare drop-off or pick-up where everyone just has tunnel vision,” Helms added. “And I think it’s hard to make friends when you're feeling vulnerable.”

Gawlik pointed to the ancillary negative impacts of loneliness.

“Loneliness has been shown to affect both your physical and mental health,” Gawlik explained. “So anything from cardiovascular disease to depression, anxiety, cognitive decline, even your immune system can be affected when you're lonely. In fact, one study showed if you are in social isolation for a prolonged amount of time, it's equivalent to smoking about 15 cigarettes a day.”

In response to the realities of parental isolation, loneliness and burnout, Gawlik created a six-week parenting program that brings parents together to be vulnerable, commiserate about challenges they face and find support. It’s where Helms realized she wasn’t alone.

“I think the biggest thing is she validated that if you’re working and you have children and you're a conscientious parent, it would be wild if you weren't burned out,” Helms said. “So I felt very validated when she said, “It’s okay that you’re here.’”

Gawlik also stressed the need for self-care and the value of connection.

“To have somebody that you can relate to and that feeling of connection that somebody else is dealing with what you are dealing with can be so powerful when it comes to combating feelings of loneliness,” Gawlik said.

“I think it equips us to create better futures for our children; I think it makes us healthier,” Helms said. “I think that the ripple effect from connecting with other parents and getting support when you need it is immeasurable. It makes you a better employee. It makes you a better spouse, parent, friend. I think that it just enriches our lives … just like parenting does, but it just makes you level up.”

Gawlik recommends doing an online search for parent groups in your community, whether they are hosted at community centers or through your employer. Parents can also look for playgroups, book clubs, recreational sports leagues or initiate talking to parents about scheduling playdates with their little ones’ friends from childcare.

“Parenting can feel very lonely at times, but it will be easier if you have people around who can support you,” Gawlik said. “It can be hard to start seeking out connections because, to some degree, you will have to be vulnerable and, sometimes, it will take time and effort.

“But just take the first step.”

Media coverage of this story:

• NBC's Today Show ( video story and sidebar article )
• ABC's Good Morning America
• yahoo! life

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College ranks 6th among public institutions

For the first time in its history, The Ohio State University College of Nursing vaulted into the nation’s top 10 colleges of nursing in funding support from the National Institutes of Health (NIH).

Despite improvements in recovery procedures and outcomes after cardiac surgery, impaired cognitive function is still a quite common complication. According to the National Center for Health Statistics, 2.6 million American adults over age 65 develop delirium each year and cardiac surgery patients are among the most at risk for postoperative delirium.

Professors Jodi Ford and Natasha Slesnick lead a new $6.9M NIH/NIDA grant to create tested approaches for nurses, counselors, community and mental health service professionals to intervene

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The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include: ● Relationship Between Alcohol Use and Firearm-Involved Suicide: Findings From the National Violent Death Reporting System, 2003–2020. ● Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies. ● Emotional State Transitions in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder. ● Predictors of non-fatal suicide attempts among Veterans Health Administration (VHA) patients who experienced military sexual trauma.

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Burnout in nursing: a theoretical review

Chiara dall’ora.

1 School of Health Sciences, and Applied Research Collaboration Wessex, Highfield Campus, University of Southampton, Southampton, SO17 1BJ UK

2 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 17177 Solna, Sweden

Maria Reinius

Peter griffiths, associated data.

Not applicable

Workforce studies often identify burnout as a nursing ‘outcome’. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.

We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.

Ninety-one papers were identified. The majority ( n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.

Conclusions

The patterns identified by these studies consistently show that adverse job characteristics—high workload, low staffing levels, long shifts, and low control—are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach’s theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

Introduction

The past decades have seen a growing research and policy interest around how work organisation characteristics impact upon different outcomes in nursing. Several studies and reviews have considered relationships between work organisation variables and outcomes such as quality of care, patient safety, sickness absence, turnover, and job dissatisfaction [ 1 – 4 ]. Burnout is often identified as a nursing ‘outcome’ in workforce studies that seek to understand the effect of context and ‘inputs’ on outcomes in health care environments. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is not always elucidated in these studies.

The term burnout was introduced by Freudenberger in 1974 when he observed a loss of motivation and reduced commitment among volunteers at a mental health clinic [ 5 ]. It was Maslach who developed a scale, the Maslach Burnout Inventory (MBI), which internationally is the most widely used instrument to measure burnout [ 6 ]. According to Maslach’s conceptualisation, burnout is a response to excessive stress at work, which is characterised by feelings of being emotionally drained and lacking emotional resources—Emotional Exhaustion; by a negative and detached response to other people and loss of idealism—Depersonalisation; and by a decline in feelings of competence and performance at work—reduced Personal Accomplishment [ 7 ].

Maslach theorised that burnout is a state, which occurs as a result of a prolonged mismatch between a person and at least one of the following six dimensions of work [ 7 – 9 ]:

• Workload: excessive workload and demands, so that recovery cannot be achieved.
• Control: employees do not have sufficient control over the resources needed to complete or accomplish their job.
• Reward: lack of adequate reward for the job done. Rewards can be financial, social, and intrinsic (i.e. the pride one may experience when doing a job).
• Community: employees do not perceive a sense of positive connections with their colleagues and managers, leading to frustration and reducing the likelihood of social support.
• Fairness: a person perceiving unfairness at the workplace, including inequity of workload and pay.
• Values: employees feeling constrained by their job to act against their own values and their aspiration or when they experience conflicts between the organisation’s values.

Maslach theorised these six work characteristics as factors causing burnout and placed deterioration in employees’ health and job performance as outcomes arising from burnout [ 7 ].

Subsequent models of burnout differ from Maslach’s in one of two ways: they do not conceptualise burnout as an exclusively work-related syndrome; they view burnout as a process rather than a state [ 10 ].

The job resources-demands model [ 11 ] builds on the view of burnout as a work-based mismatch but differs from Maslach’s model in that it posits that burnout develops via two separate pathways: excessive job demands leading to exhaustion, and insufficient job resources leading to disengagement. Along with Maslach and Schaufeli, this model sees burnout as the negative pole of a continuum of employee’s well-being, with ‘work engagement’ as the positive pole [ 12 ].

Among those who regard burnout as a process, Cherniss used a longitudinal approach to investigate the development of burnout in early career human services workers. Burnout is presented as a process characterised by negative changes in attitudes and behaviours towards clients that occur over time, often associated with workers’ disillusionment about the ideals that had led them to the job [ 13 ]. Gustavsson and colleagues used this model in examining longitudinal data on early career nurses and found that exhaustion was a first phase in the burnout process, proceeding further only if nurses present dysfunctional coping (i.e. cynicism and disengagement) [ 14 ].

Shirom and colleagues suggested that burnout occurs when individuals exhaust their resources due to long-term exposures to emotionally demanding circumstances in both work and life settings, suggesting that burnout is not exclusively an occupational syndrome [ 15 , 16 ].

This review aims to identify research that has examined theorised relationships with burnout, in order to determine what is known (and not known) about the factors associated with burnout in nursing and to determine the extent to which studies have been underpinned by, and/or have supported or refuted, theories of burnout.

This was a theoretical review conducted according to the methodology outlined by Campbell et al. and Pare et al. [ 17 , 18 ]. Theoretical reviews draw on empirical studies to understand a concept from a theoretical perspective and highlight knowledge gaps. Theoretical reviews are systematic in terms of searching and inclusion/exclusion criteria and do not include a formal appraisal of quality. They have been previously used in nursing, but not focussing on burnout [ 19 ]. While no reporting guideline for theoretical reviews currently exists, the PRISMA-ScR was deemed to be suitable, with some modifications, to enhance the transparency of reporting for the purposes of this review. The checklist, which can be found as Additional file 2 , has been modified as follows:

• Checklist title has been modified to indicate that the checklist has been adapted for theoretical reviews.
• Introduction (item 3) has been modified to reflect that the review questions lend themselves to a theoretical review approach.
• Selection of sources of evidence (item 9) has been modified to state the process for selecting sources of evidence in the theoretical review.
• Limitations (item 20) has been amended to discuss the limitations of the theoretical review process.
• Funding (item 22) has been amended to describe sources of funding and the role of funders in the theoretical review.

All changes from the original version have been highlighted.

Literature search

A systematic search of empirical studies examining burnout in nursing published in journal articles since 1975 was performed in May 2019, using MEDLINE, CINAHL, and PsycINFO. The main search terms were ‘burnout’ and ‘nursing’, using both free-search terms and indexed terms, synonyms, and abbreviations. The full search and the total number of papers identified are in Additional file 1 .

We included papers written in English that measured the association between burnout and work-related factors or outcomes in all types of nurses or nursing assistants working in a healthcare setting, including hospitals, care homes, primary care, the community, and ambulance services. Because there are different theories of burnout, we did not restrict the definition of burnout according to any specific theory. Burnout is a work-related phenomenon [ 8 ], so we excluded studies focussing exclusively on personal factors (e.g. gender, age). Our aim was to identify theorised relationships; therefore, we excluded studies which were only comparing the levels of burnout among different settings (e.g. in cancer services vs emergency departments). We excluded literature reviews, commentaries, and editorials.

Data extraction and quality appraisal

The following data were extracted from included studies: country, setting, sample size, staff group, measure of burnout, variables the relationship with burnout was tested against, and findings against the hypothesised relationships. One reviewer (MEB) extracted data from all the studies, with CDO and JEB extracting 10 studies each to check for agreement in data extraction. In line with the theoretical review methodology, we did not formally assess the quality of studies [ 19 ]. However, in Additional file 3 , we have summarised the key aspects of quality for each study, covering generalisability (e.g. a multisite study with more than 500 participants); risk of bias from common methods variance (e.g. burnout and correlates assessed with the same survey. This bias arises when there is a shared (common) variance because of the common method rather than a true (causal) association between variables); evidence of clustering (e.g. nurses nested in wards, wards nested in hospitals); and evidence of statistical adjustment (e.g. the association between burnout and correlates has been adjusted to control for potentially influencing variables). It should be noted that cells are shaded in green when the above-mentioned quality standards have been met, and in red when they have not. In the ‘Discussion’ section, we offer a reflection on the common limitations of research in the field and present a graphic summary of the ‘strength of evidence’ in Fig. ​ Fig.1 1 .

Graphical representation of strength of relationships with burnout

Data synthesis

Due to the breadth of the evidence, we summarised extracted data by identifying common categories through a coding frame. The starting point of the coding frame was the burnout multidimensional theory outlined by Maslach [ 7 ]. We then considered whether the studies’ variables fit into Maslach’s categorisation, and where they did not, we created new categories. We identified nine broad categories: (1) Areas of Worklife; (2) Workload and Staffing Levels; (3) Job Control, Reward, Values, Fairness, and Community; (4) Shift Work and Working Patterns; (5) Psychological Demands and Job Complexity; (6) Support Factors: Working Relationships and Leadership; (7) Work Environment and Hospital Characteristics; (8) Staff Outcomes and Job Performance; and (9) Patient Care and Outcomes. In the literature, categories 1–7 were treated as predictors of burnout and categories 8 and 9 as outcomes, with the exception of missed care and job satisfaction which were treated both as predictors and outcomes.

When the coding frame was finalised, CDO and MLR applied it to all studies. Where there was disagreement, a third reviewer (JEB) made the final decision.

The database search yielded 12 248 studies, of which 11 870 were rapidly excluded as either duplicates or titles and/or abstract not meeting the inclusion criteria. Of the 368 studies accessed in full text, 277 were excluded, and 91 studies were included in the review. Figure ​ Figure2 2 presents a flow chart of the study selection.

Study selection flow chart

The 91 studies identified covered 28 countries; four studies included multiple countries, and in one, the country was not reported. Most were from North America ( n = 35), Europe ( n = 28), and Asia ( n = 18).

The majority had cross-sectional designs ( n = 87, 97%); of these, 84 were entirely survey-based. Three studies were longitudinal. Most studies were undertaken in hospitals ( n = 82). Eight studies surveyed nurses at a national level, regardless of their work setting.

Sample sizes ranged from hundreds of hospitals (max = 927) with hundreds of thousands of nurses (max = 326 750) [ 20 ] to small single-site studies with the smallest sample being 73 nurses [ 21 ] (see Additional file 3 ).

The relationships examined are summarised in Table ​ Table1 1 .

Summary of studies’ results

*Partial evidence (e.g. relationship established with some but not all burnout subscales)

**Refuted when there is consistent evidence that a hypothesised relationship does not exist (e.g. large studies with no confidence intervals shown if no association)

***Observed in multiple directions

Measures of burnout

Most studies used the Maslach Burnout Inventory Scale ( n = 81), which comprises three subscales reflecting the theoretical model: Emotional Exhaustion, Depersonalisation, and reduced Personal Accomplishment. However, less than half (47%, n = 39) of the papers measured and reported results with all three subscales. Twenty-three papers used the Emotional Exhaustion subscale only, and 11 papers used the Emotional Exhaustion and Depersonalisation subscales. In nine studies, the three MBI subscales were summed up to provide a composite score of burnout, despite Maslach and colleagues advising against such an approach [ 22 ].

Five studies used the Copenhagen Burnout Inventory (CBI) [ 23 ]. This scale consists of three dimensions of burnout: personal, work-related, and client-related. Two studies used the Malach-Pines Scale [ 24 ], and one used the burnout subscale of the Professional Quality of Life Measure (ProQoL5) scale, which posits burnout as an element of compassion fatigue [ 25 ]. Two studies used idiosyncratic measures of burnout based on items from other instruments [ 20 , 26 ].

Factors examined in relation to burnout: an overview

The studies which tested the relationships between burnout and Maslach’s six areas of worklife—workload, control, reward, community, fairness, and values—typically supported Maslach’s theory that these areas are predictors of burnout. However, some evidence is based only on certain MBI dimensions. High scores on the Areas of Worklife Scale [ 27 ] (indicating a higher degree of congruence between the job and the respondent) were associated with less likelihood of burnout, either directly [ 28 , 29 ] or through high occupational coping self-efficacy [ 30 ] and presence of civility norms and co-worker incivility [ 31 ].

The majority of studies looking at job characteristics hypothesised by the Maslach model considered workload ( n = 31) and job control and reward ( n = 10). While only a few studies ( n = 9) explicitly examined the hypothesised relationships between burnout and community, fairness, or values, we identified 39 studies that covered ‘supportive factors’ including relationships with colleagues and leadership.

A large number of studies included factors that fall outside of the Maslach model. Six main areas were identified:

• Working patterns and shifts working ( n = 15)
• Features inherent in the job such as psychological demand and complexity ( n = 24)
• Job support from working relationships and leadership ( n = 39)
• Hospital or environmental characteristics ( n = 28)
• Staff outcomes and job performance ( n = 33)
• Patient outcomes ( n = 17)
• Individual attributes (personal or professional) ( n = 16)

Workload and staffing levels

Workload and characteristics of jobs that contribute to workload, such as staffing levels, were the most frequently examined factor in relation to burnout. Thirty studies found an association between high workload and burnout.

Of these, 13 studies looked specifically at measures of workload as a predictor of burnout. Workload was associated with Emotional Exhaustion in five studies [ 32 – 36 ], with some studies also reporting a relationship with Depersonalisation, and others Cynicism. Janssen reported that ‘mental work overload’ predicted Emotional Exhaustion [ 37 ]. Three studies concluded that workload is associated with both Emotional Exhaustion and Depersonalisation [ 38 – 40 ]. Kitaoka-Higashiguchi tested a model of burnout and found that heavy workload predicted Emotional Exhaustion, which in turn predicted Cynicism [ 41 ]. This was also observed in a larger study by Greengrass et al. who found that high workload was associated with Emotional Exhaustion, which consequently predicted Cynicism [ 42 ]. One study reported no association between workload and burnout components [ 43 ], and one study found an association between manageable workload and a composite burnout score [ 44 ].

Further 15 studies looked specifically at nurse staffing levels, and most reported that when nurses were caring for a higher number of patients or were reporting staffing inadequacy, they were more likely to experience burnout. No studies found an association between better staffing levels and burnout.

While three studies did not find a significant association with staffing levels [ 32 , 45 , 46 ], three studies found that higher patient-to-nurse ratios were associated with Emotional Exhaustion [ 47 – 49 ], and in one study, higher patient-to-nurse-ratios were associated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment [ 50 ]. One study concluded that Emotional Exhaustion mediated the relationship between patient-to-nurse ratios and patient safety [ 51 ]. Akman and colleagues found that the lower the number of patients nurses were responsible for, the lower the burnout composite score [ 52 ]. Similar results were highlighted by Faller and colleagues [ 53 ]. Lower RN hours per patient day were associated with burnout in a study by Thompson [ 20 ].

When newly qualified RNs reported being short-staffed, they were more likely to report Emotional Exhaustion and Cynicism 1 year later [ 54 ]. In a further study, low staffing adequacy was associated with Emotional Exhaustion [ 55 ]. Similarly, Leineweber and colleagues found that poor staff adequacy was associated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment [ 56 ]. Leiter and Spence Laschinger explored the relationship between staffing adequacy and all MBI subscales and found that Emotional Exhaustion mediated the relationship between staffing adequacy and Depersonalisation [ 57 ]. Time pressure was investigated in three studies, which all concluded that reported time pressure was associated with Emotional Exhaustion [ 58 – 60 ].

In summary, there is evidence that high workload is associated with Emotional Exhaustion, nurse staffing levels are associated with burnout, and time pressure is associated with Emotional Exhaustion.

Job control, reward, values, fairness, and community

Having control over the job was examined in seven studies. Galletta et al. found that low job control was associated with all MBI subscales [ 40 ], as did Gandi et al. [ 61 ]. Leiter and Maslach found that control predicted fairness, reward, and community, and in turn, fairness predicted values, and values predicted all MBI subscales [ 35 ]. Low control predicted Emotional Exhaustion only for nurses working the day shift [ 62 ], and Emotional Exhaustion was significantly related to control over practice setting [ 63 ]; two studies reported no effect of job control on burnout [ 44 , 64 ].

Reward predicted Cynicism [ 35 ] and burnout on a composite score [ 44 ]. Shamian and colleagues found that a higher score in the effort and reward imbalance scale was associated with Emotional Exhaustion, and higher scores in the effort and reward imbalance scale were associated with burnout measured by the CBI [ 65 ].

Value congruence refers to a match between the requirements of the job and people’s personal principles [ 7 ]. Value conflicts were related with a composite score of burnout [ 44 ], and one study concluded that nurses with a high value congruence reported lower Emotional Exhaustion than those with a low value congruence, and nurses with a low value congruence experienced more severe Depersonalisation than nurses with a high value congruence [ 66 ]. Low value congruence was a predictor of all three MBI dimensions [ 35 ] and of burnout measured with the Malach-Pines Burnout Scale [ 67 ]. Two studies considered social capital, defined as a social structure that benefits its members including trust, reciprocity, and a set of shared values, and they both concluded that lower social capital in the hospital-predicted Emotional Exhaustion [ 33 , 36 ]. A single study showed fairness predicted values, which in turn predicted all MBI Scales [ 35 ]. Two studies looked at community, and one found that community predicts a composite score of burnout [ 44 ], while the other found no relationships [ 35 ].

While not directly expressed in the terms described by Maslach, other studies demonstrate associations with possible causal factors, many of which are reflected in Maslach’s theory.

In summary, there is evidence that control over the job is associated with reduced burnout, and value congruence is associated with reduced Emotional Exhaustion and Depersonalisation.

Working patterns and shift work

Shift work and working patterns variables were considered by 15 studies. Overall, there was mixed evidence on the relationship between night work, number of hours worked per week, and burnout, with more conclusive results regarding the association between long shifts and burnout, and the potential protective effect of schedule flexibility.

Working night shifts was associated with burnout (composite score) [ 68 ] and Emotional Exhaustion [ 62 ], but the relationship was not significant in two studies [ 69 , 70 ]. Working on permanent as opposed to rotating shift patterns did not impact burnout [ 71 ], but working irregular shifts did impact a composite burnout score [ 72 ]. When nurses reported working a higher number of shifts, they were more likely to report higher burnout composite scores [ 68 ], but results did not generalise in a further study [ 69 ]. One study found working that overtime was associated with composite MBI score [ 73 ]. On-call requirement was not significantly associated with any MBI dimensions [ 71 ].

The number of hours worked per week was not a significant predictor of burnout according to two studies [ 25 , 53 ], but having a higher number of weekly hours was associated with Emotional Exhaustion and Depersonalisation in one study [ 70 ]. Long shifts of 12 h or more were associated with all MBI subscales [ 74 ] and with Emotional Exhaustion [ 49 , 75 ]. A study using the ProQoL5 burnout scale found that shorter shifts were protective of burnout [ 25 ].

Having higher schedule flexibility was protective of Emotional Exhaustion [ 46 ], and so was the ability to schedule days off for a burnout composite score [ 76 ]. Having more than 8 days off per month was associated with lower burnout [ 69 ]. Stone et al. found that a positive scheduling climate was protective of Emotional Exhaustion only [ 77 ].

In summary, we found an association between ≥ 12-h shifts and Emotional Exhaustion and between schedule flexibility and reduced Emotional Exhaustion.

Psychological demands and job complexity

There is evidence from 24 studies that job demands and aspects intrinsic to the job, including role conflict, autonomy, and task variety, are associated with some burnout dimensions.

Eight studies considered psychological demands. The higher the psychological demands, the higher the likelihood of experiencing all burnout dimensions [ 72 ], and high psychological demands were associated with higher odds of Emotional Exhaustion [ 62 , 78 ]. Emotional demands, in terms of hindrances, had an effect on burnout [ 67 ]. One study reported that job demands, measured with the Effort-Reward Imbalance Questionnaire, were correlated with all burnout dimensions [ 79 ], and similarly, Garcia-Sierra et al. found that demands predict burnout, measured with a composite scale of Emotional Exhaustion and Cynicism [ 80 ]. According to one study, job demands were not associated with burnout [ 73 ], and Rouxel et al. concluded that the higher the job demands, the higher the impact on both Emotional Exhaustion and Depersonalisation [ 64 ].

Four studies looked at task nature and variety, quality of job content, in terms of skill variety, skill discretion, task identity, task significance, influenced Emotional Exhaustion through intrinsic work motivation [ 37 ]. Skill variety and task significance were related to Emotional Exhaustion; task significance was also related to Personal Accomplishment [ 60 ]. Having no administrative tasks in the job was associated with a reduced likelihood to experience Depersonalisation [ 71 ]. Higher task clarity was associated with reduced levels of Emotional Exhaustion and increased Personal Accomplishment [ 58 ].

Patient characteristics/requirements were investigated in four papers. When nurses were caring for suffering patients and patients who had multiple requirements, they were more likely to experience Emotional Exhaustion and Cynicism. Similarly, caring for a dying patient and having a high number of decisions to forego life-sustaining treatments were associated with a higher likelihood of burnout (measured with a composite score) [ 76 ]. Stress resulting from patient care was associated with a composite burnout score [ 73 ]. Patient violence also had an impact on burnout, measured with CBI [ 81 ], as did conflict with patients [ 76 ].

Role conflict is a situation in which contradictory, competing, or incompatible expectations are placed on an individual by two or more roles held at the same time. Role conflict predicted Emotional Exhaustion [ 41 ], and so it did in a study by Konstantinou et al., who found that role conflict was associated with Emotional Exhaustion and Depersonalisation [ 34 ]; Levert and colleagues reported that role conflict correlated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment. They also considered role ambiguity, which correlated with Emotional Exhaustion and Depersonalisation, but not Personal Accomplishment [ 39 ]. Andela et al. investigated the impact of emotional dissonance, defined as the mismatch between the emotions that are felt and the emotions required to be displayed by organisations. They reported that emotional dissonance is a mediator between job aspects (i.e. workload, patient characteristics, and team issues) and Emotional Exhaustion and Cynicism. Rouxel et al. found that perceived negative display rules were associated with Emotional Exhaustion [ 64 ].

Autonomy related to Emotional Exhaustion and Depersonalisation [ 60 ], and in another study, it only related to Depersonalisation [ 43 ]. Low autonomy impacted Emotional Exhaustion via organisational trust [ 82 ]. Autonomy correlated with burnout [ 67 ]. There was no effect of autonomy on burnout according to two studies [ 58 , 63 ]. Low decision-making at the ward level was associated with all MBI subscales [ 77 ]. Decision latitude impacted Personal Accomplishment only [ 36 ], and in one study, it was found to be related to Emotional Exhaustion [ 78 ]. High decision latitude was associated with Personal Accomplishment [ 41 ] and low Emotional Exhaustion [ 33 ].

Overall, high job and psychological demands were associated with Emotional Exhaustion, as was role conflict. Patient complexity was associated with burnout, while task variety, autonomy, and decision latitude were protective of burnout.

Working relationships and leadership

Overall, evidence from 39 studies supports that having positive support factors and working relationships in place, including positive relationships with physicians, support from the leader, positive leadership style, and teamwork, might play a protective role towards burnout.

The quality of the relationship with physicians was investigated by 12 studies. In two studies, having negative relationships with physicians was associated with all MBI dimensions [ 77 , 83 ]; quality of nurse-physician relationship was associated with Emotional Exhaustion and Depersonalisation, but not PA [ 50 ]. Two studies found an association with Emotional Exhaustion only [ 55 , 84 ], and one concluded that quality of relationship with physicians indirectly supported PA [ 36 ]. This was also found by Leiter and Laschinger, who found that positive nurse-physician collaborations predicted Personal Accomplishment [ 57 , 85 ]. When burnout was measured with composite scores of MBI and a not validated scale, two studies reported an association with nurse-physician relationship [ 20 , 76 ], and two studies found no associations [ 56 , 63 ].

Having support from the supervisor or leader was considered in 12 studies, which found relationships with different MBI dimensions. A relationship between low support from nurse managers and all MBI subscales was observed in one study [ 77 ], while two studies reported it is a protective factor from Emotional Exhaustion only [ 58 , 83 ], and one that it was also associated with Depersonalisation [ 86 ]. Kitaoka-Higashiguchi reported an association only with Cynicism [ 41 ], and Jansen et al. found it was only associated with Depersonalisation and Personal Accomplishment [ 60 ]. Van Bogaert and colleagues found that support from managers predicted low Emotional Exhaustion and high Personal Accomplishment [ 84 ], but in a later study, it only predicted high Personal Accomplishment [ 36 ]. Regarding the relationship with the manager, it had a direct effect on Depersonalisation, and it moderated the effect of time pressure on Emotional Exhaustion and Depersonalisation [ 59 ]; a protective effect of a quality relationship with the head nurse on a composite burnout score was also reported [ 76 ]. Two studies using different burnout scales found an association between manager support and reduced burnout [ 25 , 67 ]. Low trust in the leader showed a negative impact on burnout, measured with a composite score [ 87 ]. Two further studies focused on the perceived nurse manager’s ability: authors found that it was related to Emotional Exhaustion [ 46 ], and Emotional Exhaustion and Personal Accomplishment [ 50 ].

Fourteen studies looked at the leadership style and found that it affects burnout through different pathways and mechanisms. Boamah et al. found that authentic leadership—described as leaders who have high self-awareness, balanced processing, an internalised moral perspective, and transparency—predicted higher empowerment, which in turn predicted lower levels of Emotional Exhaustion and Cynicism a year later [ 54 ]. Authentic leadership had a negative direct effect on workplace bullying, which in turn had a direct positive effect on Emotional Exhaustion [ 88 ]. Effective leadership predicted staffing adequacy, which in turn predicted Emotional Exhaustion [ 57 , 85 ]. Authentic leadership predicted all areas of worklife, which in turn predicted all MBI dimensions of burnout [ 30 ], and a similar pathway was identified by Laschiner and Read, although authentic leadership impacted Emotional Exhaustion only and it was also through civility norms and co-worker incivility [ 31 ]. Emotional Exhaustion mediated the relationship between authentic leadership and intention to leave the job [ 89 ]. ‘Leader empowering behaviour’ had an indirect effect on Emotional Exhaustion through structural empowerment [ 29 ], and empowering leadership predicted trust in the leader, which in turn was associated with burnout composite score [ 87 ]. Active management-by-exception was beneficial for Depersonalisation and Personal Accomplishment, passive laissez-faire leadership negatively affected Emotional Exhaustion and Personal Accomplishment, and rewarding transformational leadership protected from Depersonalisation [ 90 ]. Contrary to this, Madathil et al. found that transformational leadership protected against Emotional Exhaustion, but not Depersonalisation, and promoted Personal Accomplishment [ 43 ]. Transformational leadership predicted positive work environments, which in turn predicted lower burnout (composite score) [ 44 ]. Positive leadership affected Emotional Exhaustion and Depersonalisation [ 56 ] and burnout measured with a non-validated scale [ 20 ].

Teamwork and social support were also explored. Co-worker cohesion was only related to Depersonalisation [ 58 ]; team collaboration problems predicted negative scores on all MBI subscales [ 38 ], and workplace support protected from Emotional Exhaustion [ 72 ]. Similarly, support received from peers had a protective effect on Emotional Exhaustion [ 60 ]. Collegial support was related to Emotional Exhaustion and Personal Accomplishment [ 39 ], and colleague support protected from burnout [ 67 ]. Interpersonal conflict affected Emotional Exhaustion through role conflict, but co-worker support had no effect on any burnout dimensions [ 41 ], and similarly, co-worker incivility predicted Emotional Exhaustion [ 31 ], and so did bullying [ 88 ]. Poor team communication was associated with all MBI dimensions [ 40 ], staff issues predicted burnout measured with a composite score [ 73 ], and so did verbal violence from colleagues [ 68 ]. One study found that seeking social support was not associated with any of the burnout dimensions, while another study found that low social support predicted Emotional Exhaustion [ 37 ], and social support was associated with lower Emotional Exhaustion and higher Personal Accomplishment [ 21 ]. Vidotti et al. found an association between low social support and all MBI dimensions [ 62 ].

Work environment and hospital characteristics

Eleven studies were considering the work environment measured with the PES-NWI scale [ 91 ], where higher scores indicate positive work environments. Five studies comprising diverse samples and settings concluded that the better rated the work environment, the lower the likelihood of experiencing Emotional Exhaustion [ 32 , 47 , 49 , 51 , 92 ], and four studies found the same relationship, but on both Emotional Exhaustion and Depersonalisation [ 50 , 66 , 93 , 94 ]; only one study concluded there is an association between work environment and all MBI dimensions [ 95 ]. Negative work environments affected burnout (measured with a composite score) via job dissatisfaction [ 96 ]. One study looked at organisational characteristics on a single scale and found that a higher rating of organisational characteristics predicted lower Emotional Exhaustion [ 82 ]. Environmental uncertainty was related to all MBI dimensions [ 86 ].

Structural empowerment was also considered in relation to burnout: high structural empowerment led to lower Emotional Exhaustion and Cynicism via staffing levels and worklife interference [ 54 ]; in a study using a similar methodology, structural empowerment affected Emotional Exhaustion via Areas of Worklife [ 29 ]. The relationship between Emotional Exhaustion and Cynicism was moderated by organisational empowerment [ 40 ], and organisational support had a protective effect on burnout [ 67 ]. Hospital management and organisational support had a direct effect on Emotional Exhaustion and Personal Accomplishment [ 84 ]. Trust in the organisation predicted lower levels of Emotional Exhaustion [ 82 ] and of burnout measured with a composite MBI score [ 87 ].

Three studies considered whether policy involvement had an effect on burnout. Two studies on the same sample found that having the opportunity to participate in policy decisions was associated with reduced burnout (all subscales) [ 57 , 85 ], and one study did not report results for the association [ 20 ]. Emotional Exhaustion mediated the relationship between nurses’ participation in hospital affairs and their intention to leave the job [ 97 ]; a further study did not found an association between participation in hospital affairs and Emotional Exhaustion, but only with Personal Accomplishment [ 50 ]. Lastly, one study investigated participation in research groups and concluded it was associated with reduced burnout measured with a composite score [ 76 ].

There was an association between opportunity for career advancement and all MBI dimensions [ 77 ]; however, another study found that having promotion opportunities was not related to burnout [ 79 ]. Moloney et al. found that professional development was not related to burnout [ 67 ]. Two studies considered pay. In one study, no effect was found on any MBI dimension [ 73 ], and a very small study ( n = 78 nurses) reported an effect of satisfaction with pay on Emotional Exhaustion and Depersonalisation [ 34 ]. Job insecurity predicted Depersonalisation and PA [ 79 ].

When the hospital adopted nursing models of care rather than medical models of care, nurses were more likely to report high levels of Personal Accomplishment [ 57 , 85 ]. However, another study found no significant relationship [ 20 ]. Regarding ward and hospital type, Aiken and Sloane found that RNs working in specialised AIDS units reported lower levels of Emotional Exhaustion [ 98 ]; however, ward type was not found to be significantly associated with burnout in a study on temporary nurses [ 53 ]. Working in different ward settings was not associated with burnout, but working in hospitals as opposed to in primary care was associated with lower Emotional Exhaustion [ 71 ]. Working in a small hospital was associated with a lower likelihood of Emotional Exhaustion, when compared to working in a community hospital [ 63 ]. Faller’s study also concluded that working in California was a significant predictor of reduced burnout.

When the hospitals’ investment in the quality of care was considered, one study found that having foundations for quality of care was associated with reduced Emotional Exhaustion only [ 50 ], but in another study, foundations for quality of care were associated with all MBI dimensions [ 83 ]. Working in a Magnet hospital was not associated with burnout [ 53 ].

In summary, having a positive work environment (generally work environments scoring higher on the PES-NWI scale) was associated with reduced Emotional Exhaustion, and so was higher structural empowerment. However, none of the organisational characteristics at the hospital level was consistently associated with burnout.

Staff outcomes and job performance

Nineteen studies considered the impact of burnout on intention to leave. Two studies found that Emotional Exhaustion and Cynicism had a direct effect on turnover intentions [ 28 , 99 ], and four studies reported that only Emotional Exhaustion affected intentions to leave the job [ 21 , 32 , 37 , 100 ], with one of these indicating that Emotional Exhaustion affected also intention to leave the organisation [ 32 ], but one study did not replicate such findings [ 101 ] and concluded that only Cynicism was associated with intention to leave the job and nursing. Similarly, one study found that Cynicism was directly related to intention to leave [ 35 ]. A further study found that Emotional Exhaustion affected turnover intentions via job satisfaction [ 88 ], and one article reported that Emotional Exhaustion mediated the effect of authentic leadership on intention to leave [ 89 ]. Emotional Exhaustion was a mediator between nurses’ involvement with decisions and intention to leave the organisation [ 97 ]. Burnout measured on a composite score was associated with a higher intention to leave [ 96 ]. Laeeque et al. reported that burnout, captured with CBI, related to intention to leave [ 81 ]; Estryn-Behar et al. used the same scale to measure burnout and found that high burnout was associated with higher intention to leave in all countries, except for Slovakia [ 102 ]. Burnout, measured with the Malach-Pines Scale, was associated with intention to quit, and stronger associations were found for nurses who had higher perceptions of organisational politics [ 103 ]. Burnout (Malach-Pines Scale) predicted both the intention to leave the job and nursing [ 67 ]. Three studies investigated the relationship between burnout and intention to leave; one of these aggregated all job outcomes in a single variable (i.e. job satisfaction, intention to leave the hospital, applied for another job, and intention to leave nursing) and reported that Depersonalisation and Personal Accomplishment predict job outcomes [ 84 ]; they replicated a similar approach and found the same associations [ 36 ]. They later found that all MBI dimensions were associated with leaving the nursing profession [ 104 ]. Only one study in a sample of 106 nurses from one hospital found an association between Depersonalisation and turnover within 2 years [ 105 ].

Two studies looked at the effect of burnout on job performance: one found a negative association between burnout (measured with CBI) and both task performance and contextual performance [ 106 ]. Only Emotional Exhaustion was associated with self-rated and supervisor-rated job performance of 73 RNs [ 21 ]. Missed care was investigated in three studies, and it was found to be both predictor of Emotional Exhaustion [ 32 ], an outcome of burnout [ 20 , 103 ].

Four studies considered sickness absence. When RNs had high levels of Emotional Exhaustion, they were more likely to experience short-term sickness absence (i.e. 1–10 days of absence), which was obtained from hospital administrative records. Similarly, Emotional Exhaustion was associated with seven or more days of absence in a longitudinal study [ 105 ]. Emotional Exhaustion was significantly associated with reported mental health absenteeism, but not reported physical health absenteeism, and sickness absence from administrative records [ 21 ]. One study did not find any meaningful relationships between burnout and absenteeism [ 107 ].

Emotional Exhaustion was a significant predictor of general health [ 73 ], and in a further study, both Emotional Exhaustion and Personal Accomplishment were associated with perceived health [ 70 ]. Final-year nursing students who experienced health issues were more likely to develop high burnout when entering the profession [ 26 ]. When quality of sleep was treated both as a predictor and outcome of burnout, relationships were found in both instances [ 106 ].

Focussing on mental health, one study found that burnout predicted mental health problems for newly qualified nurses [ 30 ], and Emotional Exhaustion and Cynicism predicted somatisation [ 42 ]. Depressive symptoms were predictive of Emotional Exhaustion and Depersonalisation, considering therefore depression as a predictor of burnout [ 108 ]. Rudman and Gustavsson also found that having depressive mood and depressive episodes were common features of newly qualified nurses who developed or got worse levels of burnout throughout their first years in the profession [ 26 ]. Tourigny et al. considered depression as a predictor and found it was significantly related to Emotional Exhaustion [ 107 ].

Eleven studies considered job satisfaction: of these, three treated job satisfaction as a predictor of burnout and concluded that higher levels of job satisfaction were associated with a lower level of composite burnout scores [ 52 , 96 ] and all MBI dimensions [ 94 ]. According to two studies, Emotional Exhaustion and Cynicism predicted job dissatisfaction [ 54 , 101 ], while four studies reported that Emotional Exhaustion only was associated with increased odds to report job dissatisfaction [ 73 , 82 , 88 , 100 ]; one study reported that Cynicism only was associated with job dissatisfaction [ 99 ]. Rouxel et al. did not find support in their hypothesised model that Emotional Exhaustion and Depersonalisation predicted job satisfaction [ 64 ].

In summary, considering 39 studies, there is conflicting evidence on the direction of the relationship between burnout and missed care, mental health, and job satisfaction. An association between burnout and intention to leave was found, although only one small study reported an association between burnout and turnover. A moderate relationship was found for the effect of burnout on sickness absence, job performance, and general health.

Patient care and outcomes

Among the patient outcomes of burnout, quality of care was investigated by eight studies. Two studies in diverse samples and settings reported that high Emotional Exhaustion, high Depersonalisation, and low Personal Accomplishment were associated with poor quality of care [ 109 , 110 ], but one study found that only Personal Accomplishment was related to better quality of care at the last shift [ 104 ]; Emotional Exhaustion and Cynicism predict low quality of care [ 54 ]; two articles reported that Emotional Exhaustion predicts poor nurse ratings of quality of care [ 82 , 84 ]. A high burnout composite score predicted poor nurse-assessed quality of care [ 96 ]. In one instance, no associations were found between any of the burnout dimensions and quality of care [ 36 ].

Five studies considered aspects of patient safety: burnout was correlated with negative patient safety climate [ 111 ]. Emotional Exhaustion and Depersonalisation were both associated with negative patient safety grades and safety perceptions [ 112 ], and burnout fully mediated the relationship between depression and individual-level safety perceptions and work area/unit level safety perceptions [ 108 ]. Emotional Exhaustion mediated the relationship between workload and patient safety [ 51 ], and a higher composite burnout score was associated with lower patient safety ratings [ 113 ].

Regarding adverse events, high DEP and low Personal Accomplishment predicted a higher rate of adverse events [ 85 ], but in another study, only Emotional Exhaustion predicted adverse events [ 51 ]. When nurses were experiencing high levels of Emotional Exhaustion, they were less likely to report near misses and adverse events, and when they were experiencing high levels of Depersonalisation, they were less likely to report near misses [ 112 ].

All three MBI dimensions predicted medication errors in one study [ 109 ], but Van Bogaert et al. found that only high levels of Depersonalisation were associated with medication errors [ 104 ]. High scores in Emotional Exhaustion and Depersonalisation predicted infections [ 109 ]. Cimiotti et al. found that Emotional Exhaustion was associated with catheter-associated urinary tract infections and surgical site infections [ 114 ], while in another study, Depersonalisation was associated with nosocomial infections [ 104 ]. Lastly, patient falls were also explored, and Depersonalisation and low Personal Accomplishment were significant predictors in one study [ 109 ], while in a further study, only Depersonalisation was associated with patient falls [ 104 ]. There was no association between burnout and hospital-acquired pressure ulcers [ 20 ].

Considering patient experience, Vahey et al. concluded that higher Emotional Exhaustion and low Personal Accomplishment levels were associated with patient dissatisfaction [ 93 ], and Van Bogaert et al. found that Emotional Exhaustion was related to patient and family verbal abuse, and Depersonalisation was related to both patient and family verbal abuse and patient and family complaints [ 104 ].

In summary, evidence deriving from 17 studies points to a negative effect of burnout on quality of care, patient safety, adverse events, error reporting, medication error, infections, patient falls, patient dissatisfaction, and family complaints, but not on pressure ulcers.

Individual characteristics

In total, 16 studies, which had examined work characteristics related to burnout, also considered the relationship between characteristics of the individual and burnout. Relationships were tested on demographic variables, including gender, age, and family status; on personality aspects; on work-life interference; and on professional attributes including length of experience and educational level. Because our focus on burnout is as a job-related phenomenon, we have not reported results of these studies into detail, but overall evidence on demographic and personality factors was inconclusive, and having family issues and high work-life interference was associated with different burnout dimensions. Being younger and not having a bachelor’s degree were found to be associated with a higher incidence of burnout.

This review aimed to identify research that had examined theorised relationships with burnout, in order to determine what is known (and not known) about the factors associated with burnout in nursing and to determine the extent to which studies have been underpinned by, and/or have supported or refuted, theories of burnout. We found that the associations hypothesised by Maslach’s theory between mismatches in areas of worklife and burnout were generally supported.

Research consistently found that adverse job characteristics—high workload, low staffing levels, long shifts, low control, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity—were associated with burnout in nursing.

However few studies used all three MBI subscales in the way intended, and nine used different approaches to measuring burnout.

The field has been dominated by cross-sectional studies that seek to identify associations with one or two factors, rarely going beyond establishing correlation. Most studies were limited by their cross-sectional nature, the use of different or incorrectly applied burnout measures, the use of common methods (i.e. survey to capture both burnout and correlates), and omitted variables in the models. The 91 studies reviewed, while highlighting the importance of burnout as a feature affecting nurses and patient care, have generally lacked a theoretical approach, or identified mechanisms to test and develop a theory on the causes and consequences of burnout, but were limited in their testing of likely mechanisms due to cross-sectional and observational designs.

For example, 19 studies showed relationships between burnout and job satisfaction, missed care, and mental health. But while some studies treated these as predictors of burnout, others handled as outcomes of burnout. This highlights a further issue that characterises the burnout literature in nursing: the simultaneity bias, due to the cross-sectional nature of the evidence. The inability to establish a temporal link means limits the inference of causality [ 115 ]. Thus, a factor such as ‘missed care’ could lead to a growing sense of compromise and ‘crushed ideals’ in nurses [ 116 ], which causes burnout. Equally, it could be that job performance of nurses experiencing burnout is reduced, leading to increased levels of ‘missed care’. Both are plausible in relation to Maslach’s original theory of burnout, but research is insufficient to determine which is most likely, and thereby develop the theory.

To help address this, three areas of development within research are proposed. Future research adopting longitudinal designs that follow individuals over time would improve the potential to understand the direction of the relationships observed. Research using Maslach’s theory should use and report all three MBI dimensions; where only the Emotional Exhaustion subscale is used, this should be explicit and it should not be treated as being synonymous to burnout. Finally, to move our theoretical understanding of burnout forward, research needs to prioritise the use of empirical data on employee behaviours (such as absenteeism, turnover) rather than self-report intentions or predictions.

Addressing these gaps would provide better evidence of the nature of burnout in nursing, what causes it and its potential consequences, helping to develop evidence-based solutions and motivate work-place change. With better insight, health care organisations can set about reducing the negative consequences of having patient care provided by staff whose work has led them to become emotionally exhausted, detached, and less able to do the job, that is, burnout.

Limitations

Our theoretical review of the literature aimed to summarise information from a large quantity of studies; this meant that we had to report studies without describing their context in the text and also without providing estimates (i.e. ORs and 95% CIs). In appraising studies, we did not apply a formal quality appraisal instrument, although we noted key omissions of important details. However, the results of the review serve to illustrate the variety of factors that may influence/result from burnout and demonstrate where information is missing. We did not consider personality and other individual variables when extracting data from studies. However, Maslach and Leiter recently reiterated that although some connections have been made between burnout and personality characteristics, the evidence firmly points towards work characteristics as the primary drivers of burnout [ 8 ].

While we used a reproducible search strategy searching MEDLINE, CINAHL, and PsycINFO, it is possible that there are studies indexed elsewhere and we did not identify them, and we did not include grey literature. It seems unlikely that these exist in sufficient quantity to substantively change our conclusions.

Patterns identified across 91 studies consistently show that adverse job characteristics are associated with burnout in nursing. The potential consequences for staff and patients are severe. Maslach’s theory offers a plausible mechanism to explain the associations observed. However incomplete measurement of burnout and limited research on some relationships means that the causes and consequences of burnout cannot be reliably identified and distinguished, which makes it difficult to use the evidence to design interventions to reduce burnout.

Supplementary information

Acknowledgements.

We would like to thank Jane Lawless who performed the second screening of the provisionally included papers.

Abbreviations

Authors’ contributions.

CDO led the paper write-up at all stages, designed and conducted the search strategy, completed the initial screening of papers, co-developed the coding frame, and applied the coding frame to all studies. JB conceived the review, co-developed the coding frame, applied the coding frame to all studies, and contributed substantially to drafting the paper at various stages. MR extracted all the data from studies and produced evidence tables. PG conceived the review and contributed substantially to the drafting of the paper at various stages. All authors read and approved the final manuscript.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information accompanies this paper at 10.1186/s12960-020-00469-9.

The big burnout: Life on the front lines of America’s wildfires

Record-setting blazes are becoming more common as the number of skilled wildland firefighters dwindles, by connor goodwin.

This article originally appeared on ProPublica .

With record-setting blazes becoming more and more common, the demands placed on wildland firefighters are greater than ever. Already this year, the Smokehouse Creek Fire, which broke out in the Texas Panhandle in February, has become the second-largest wildfire in U.S. history, burning nearly 1.1 million acres. Last year, a relatively quiet fire season, saw the Lahaina fire on Maui, Hawaii’s largest-ever wildfire and one of the deadliest on record, with at least 100 fatalities. The previous year, New Mexico experienced its biggest and second-biggest fires simultaneously — the Hermits Peak-Calf Canyon Fire in the northern half of the state and the Black Fire down south.

But at this crucial hour, America’s last line of defense against fires is fraying. A recent ProPublica investigation found that the Forest Service is losing wildland firefighters , suffering an attrition rate of 45% among its permanent employees in the past three years. The investigation spotlighted the challenges that wildland firefighters face: weeklong stretches away from family, a bureaucracy indifferent to physical and mental health concerns and a byzantine pay structure that incentivizes risk.

When asked about the attrition, a Forest Service spokesperson wrote, “It is accurate to say that the U.S. Forest Service has lost firefighters to better paying jobs,” adding that the dynamic “is more pronounced in specific regions and states.”

For the fire-prone West, the stakes could not be higher. In 2022, the Hermits Peak-Calf Canyon Fire began when a federal prescribed burn escaped and merged with the smoldering remnants of another controlled burn to become New Mexico’s biggest-ever wildfire. ProPublica and its Local Reporting Network partner Source New Mexico spent more than a year reporting “ The Long Burn ” series, which chronicled the slow recovery from the fire. The reporting revealed that the Federal Emergency Management Agency had only paid out 1% of the $4 billion fund to compensate victims seven months after Congress approved it and that the agency had provided little temporary housing for survivors. The reporting also spotlighted ongoing lawsuits victims filed against FEMA to gain compensation for noneconomic damages and survivors’ hard-earned lessons learned from navigating disaster aid .

"We’re past the point of needing research. It’s absolutely clear that wildland firefighting is a cancer-causing occupation."

The U.S. Forest Service has said the wildfire prompted the agency to examine how to do its work more safely. FEMA officials have said they moved as quickly as possible to set up a claims office to pay for damages, a mission quite different from what it normally does, which is to provide short-term disaster aid. As of April 8, FEMA had paid out about 12% of the $4 billion fund.

At a recent virtual event in partnership with Source New Mexico and Outside Magazine, ProPublica convened a roundtable featuring the reporters and their sources to discuss these investigations. The first half of the hourlong discussion outlined the factors contributing to the exodus of firefighters from the Forest Service and what could be done to stem it. The second part examined the devastating aftermath of the Hermits Peak-Calf Canyon Fire, the grinding machinery of recovery under FEMA and the state of rebuilding efforts. Speakers included:

• Kit Rachils, senior editor at ProPublica
• Ben Elkind, wildland firefighter with the U.S. Forest Service
• George Broyles, former wildland firefighter and public information officer, who spearheaded the Forest Service’s research into the physiological impacts of wildfire smoke from 2008 to 2014
• Pat Lohmann, reporter for Source New Mexico
• Yolanda Cruz, New Mexico resident affected by the Hermits Peak-Calf Canyon fire
• Antonia Roybal-Mack, founder and managing partner of Roybal-Mack & Cordova PC and an attorney representing many New Mexico families affected by the fires

This interview, based on that event, has been edited for clarity and concision.

More Fires, Fewer Firefighters

Kit Rachlis: Ben, can you describe the challenges you face as you enter your 17th season fighting fires?

Ben Elkind: This year I took a job that’s three hours away from where I’ve been working for the last 10 years. The first thing I think about is, I’ve got a family in Redmond, Oregon, and we’re lucky we don’t own a house there, because now I’ve got to move. Just a few years ago, the Forest Service had a program where they would have bought your house and helped you with moving costs. Child care is difficult. One of the reasons we’re moving is so my mom can help out with child care.

Rachlis: What are the health risks of fighting wildfires? And what accounts for the Forest Service’s extraordinarily slow response to those concerns?

George Broyles: Their slowness to research dates back to 1989, when the National Wildfire Coordinating Group recommended that research needed to be done. Those experts understood there is a concern for cancer and respiratory disease for men and women like Ben who spent their career in smoke. I’m a proponent of research, but to a large degree, we’re past the point of needing research. It’s absolutely clear that wildland firefighting is a cancer-causing occupation.

Rachlis: What changes would you like to see in the Forest Service?

Broyles: I think they really need to be transparent with their employees. Exposure to noise is another topic I spent years researching, and it’s extremely hazardous. It causes hearing loss. It causes mental decomposition. It literally makes it harder to comprehend speech and think clearly, which is critical when you’re in that environment. The law is very clear on what employers have to do when folks are exposed to noise.

The agency had a small publication put out a few years ago, talking to people who wanted to become firefighters about what the risks are, but the word “cancer” was not in that. The term “noise-induced hearing loss” was not in there. These are really critical health issues that our firefighters face on a daily basis, and the agency continues to bury its head in the sand. I’ve had cancer, and I’ve got hearing loss. The young men and women coming in absolutely need to know what they’re facing. The agency has to say, “This is what we’re going to do to protect you, because when you retire, we want you to be healthier.”

Elkind: The way that we pay people with hazard pay is probably one of my top issues. The way the system works is: You’re actively incentivized to take on more risk to increase your pay for the day. You may have a lifelong illness — cancer, hearing issues — all these things you don’t get hazard pay for, even though it was from the work you did. When you retire, your hazard pay doesn’t count for your retirement pension. Also, your hazard pay doesn’t count for your worker’s compensation. It’s this pretty significant part of our income we rely on. People are getting 2,000 hours of hazard pay a year, and it’s 25% of your base pay. I think the incentives that we put in front of firefighters really need to be looked at in a holistic way, because I don’t think we’ve looked at how we’re paying people in a long, long time.

When a Controlled Burn Becomes a Wildfire

Rachlis: Through its Local Reporting Network, ProPublica worked with Source New Mexico to examine the grinding machinery of recovery under FEMA. Pat, could you provide some context about the Hermits Peak-Calf Canyon Fire and summarize the aftermath?

Pat Lohmann: New Mexico was the national epicenter for wildfire throughout the summer of 2022, where we had not only the biggest wildfire in our history, but the second biggest in southern New Mexico, called the Black Fire. What makes the Hermits Peak and the Calf Canyon fire different from the other 20 that were burning simultaneously in New Mexico is that both of them were the result of botched prescribed burns, ignited by the Forest Service on federal land. Ultimately those two fires merged and became what we know as the Hermits Peak-Calf Canyon Fire, which, over the course of several months, burned more than 530 square miles of land in a section of the Sangre de Cristo Mountains, taking with it several hundred homes and acres of trees on federal and private land.

In late 2022, Congress approved nearly $4 billion to fully compensate victims of this fire. Beginning in January of last year, the question became: When the government makes a mistake this massive, what is it going to do to fully compensate the victims of that mistake? That was the question that undergirds most of our reporting, from examining the Stafford Act programs, which are the way FEMA handles every disaster that occurs, to the establishment of the claims office and this $4 billion fund.

Rachlis: Yolanda, can you tell us about the losses you and your family have endured in the fire and the status of your claims?

Yolanda Cruz: My family and I have 10 acres of property between Sapello and Rociada, and the fire crossed over the entire 10 acres. We were very fortunate that it did not take our home. The high-severity burn came right up to where we had raked and watered. We did lose about half of the trees on the property as well as a lot of personal items — vehicles and other items in our yard. My parents live in Las Vegas, New Mexico, and they had to leave because of medical reasons. So their losses were more along the lines of smoke damage and evacuation.

I have a few proofs of loss with FEMA right now. I have received a settlement offer on the smaller claim, and I have not heard anything on the other ones. The larger one was lost by FEMA, and I found that out about a week ago. Then on my parents’ claims, I was able to help them get the one settled for their evacuation, but it did take about nine months.

Rachlis: Antonia, as the attorney for many of those families, can you describe how FEMA has handled this, or not handled this, and what you’re trying to do to rectify the situation?

Antonia Roybal-Mack: FEMA is not set up to handle large volumes of claims. FEMA does not have the legal resources, the experts or the personnel to do this. There are companies around the country that could come in and set up a large claims process like this, and FEMA has refused to do that. What we’re trying to do is get transparency for the families, get speed and make sure that families receive 100% of what they lost, because this was the fault of the federal government. I represent hundreds of families, and we just want FEMA to do their job and get people paid and get people back in homes with as little litigation as necessary.

Rachlis: Yolanda, it’s been nearly two years since the fire. What do you and your neighbors need the most right now?

Cruz: We need this to be done, so we can move forward with our lives. There are still many people who have not been able to rebuild. As I’ve said, we were very fortunate that our home was still there. But we did have substantial damage to our well, to our septic system, to our road. There’s been so much anger and mistrust, but also a lack of resources. There are people who’ve had to relocate, who’ve been displaced, and the longer this takes to get settled, the longer it takes for people to heal and move forward.

Rachlis: What lessons are to be taken away from these experiences?

Roybal-Mack: I think what we learned is that rural America is not prepared for disaster. What we also learned is that on a national level, FEMA, the agency that we think is going to show up and help when there’s a disaster, is not well prepared to do so. I think as a country, we really need to look at the role of FEMA and put resources in our Department of Homeland Security. I think governments need good emergency management plans that are updated annually, and people need to just really be prepared for disaster for themselves and for their families, because FEMA is not up to the task.

Cruz: When President Biden visited the area and said everyone would be compensated and we heard that as well from our elected officials, the private philanthropy dollars began to slow down, because everyone thought the government had this. When that didn’t happen, the local community continued to care for the people who are impacted. Now things finally seem to be moving slowly with FEMA, but it’s not enough. There is so much bureaucracy and red tape. It shouldn’t take so long. You go through a “navigator” who goes through their supervisors, who go through three or four levels up and then come three or four levels down. In that process, paperwork gets lost, people are asked to do things over and over again. And a lot of people are just giving up with the whole process. The government just needs to figure out a better way to get resources on the ground.

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox .

about the health impacts of climate change

• Sick, hot world: Climate change favors disease vectors, threatening to unleash more pandemics
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Connor Goodwin is a Communications Manager with ProPublica.

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