What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Burnout (n=410). Intervention: Emotional exhaustion. Primary outcome: Vagally-mediated heart rate variability (RMSSD) during venipuncture (ß= -0.11, p=0.03).

May 17, 2017Open Access

Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion

MKMagdalena K. KanthakTechnische Universität Dresden TSTobias StalderUniversity of Siegen LHLaBarron K. HillUniversity of North Carolina at Greensboro

Key Result

Emotional exhaustion was significantly and inversely associated with vagally-mediated heart rate variability during an emotionally-arousing venipuncture (ß= -0.11) and seated rest (ß= -0.09).

Study Design

Type

Cross-Sectional (n=410)

Structured PICO

Population

410 participants from the population-based Dresden Burnout Study, mean age 42.2 (SD 11.2) years, 33.4% male.

Outcome

Vagally-mediated heart rate variability (HRV), indexed by root mean square of successive differences (RMSSD), assessed during an emotionally-arousing situation (venipuncture), recumbent recovery, and seated rest.surrogate

Emotional exhaustion is associated with reduced vagal function, suggesting that autonomic dysregulation is a shared psychophysiological feature of both burnout and depression.

Main Result

Effect estimate: ß= -0.11

p-value: p=0.03

Limitations

Cross-sectional design does not allow assertions about causality or directionality
Unable to account for previous history of psychiatric disorders, chronic disease and medication intake
Blood sampling as a stressor may not induce strong or long-lasting emotional arousal
Resting HF-HRV was not obtained temporally independently of the emotionally-arousing situation
Lack of universally accepted diagnostic criteria for burnout
Relatively high number of statistical tests

Abstract

Objectives Given the important role of the autonomic nervous system (ANS) in stress regulation, astonishingly little is known about ANS functioning in burnout, a condition arising after prolonged exposure to work-related stress. The current study sought to investigate ANS modulation, as indexed by vagally-mediated heart rate variability (HRV), in relation to burnout symptomatology to (i) distinguish associations between the three dimensions of burnout emotional exhaustion (EE), cynicism, reduced personal accomplishment and (ii) investigate overlap in associations with depressive symptomatology. Methods Assessments of vagally-mediated HRV (ie, root mean square of successive differences, RMSSD) were conducted in a large population-based sample from the Dresden Burnout Study N=410, mean age 42.2, standard deviation (SD) 11.2 years; 33.4% male. Vagally-mediated HRV was assessed for 90 seconds during an emotionally-arousing situation (venipuncture, recumbent), a 335-second recumbent recovery period, and a 335-second seated resting condition. Results Results from multiple linear regression analyses revealed that EE was negatively related to RMSSD during venipuncture (=β -0.11, P=0.03) and the seated rest (β= -0.09, P=0.04) even after accounting for established ANS modulators (eg, age, body mass index). This pattern was not observed for the other dimensions of burnout. Exploratory analyses of depressive symptomatology further revealed that RMSSD was significantly and inversely associated with burnout-related symptoms but not with the core criteria of depression (eg, depressed mood). Conclusions This study presents evidence for a link between exhaustion and reduced vagal function, both in burnout and depression, suggesting that ANS modulations may not be disorder-specific but rather a psychophysiological correlate of an underlying feature shared by both conditions.

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