The Association Between Burnout, Depression, Anxiety,
and
Inflammation
Biomarkers: C-Reactive Protein and Fibrinogen in
Men
and Women
Sharon Toker and Arie Shirom
Tel Aviv University
Itzhak Shapira and Shlomo Berliner
Tel Aviv Sourasky Medical Center
Samuel Melamed
National Institute of Occupational & Environmental Health and
Tel Aviv University
Following the demonstrated association of employee burnout or vital
exhaustion with several risk
factors for cardiovascular disease (CVD) and CVD risk, the
authors investigated the possibility
that one of the mechanisms linking burnout with CVD morbidity
is microinflammation, gauged
in
this study by high-sensitivity C-reactive protein (hs-CRP) and
fibrinogen concentrations. Their
sample included 630 women and 933 men, all apparently
healthy, who underwent periodic health
examinations. The authors controlled for possible confounders
including 2 other negative affec-
tive states: depression and anxiety. In women, burnout was
positively associated with hs-CRP and
fibrinogen concentrations, and anxiety was negatively
associated with them. In men, depression
was
positively associated with hs-CRP and fibrinogen concentrations,
but not with burnout or
anxiety. Thus, burnout, depression, and anxiety are
differentially associated with microinflam-
mation biomarkers, dependent on gender.
Burnout is a chronic affective state comprised
of
emotional exhaustion, physical fatigue, and
cognitive
weariness (Shirom, 1989, 2003). It is an outcome
of
chronic depletion of the individual’s coping re-
sources resulting from prolonged exposure to
stress,
particularly work-related stress. Whereas early
burn-
out
research focused on its attitudinal and organiza-
tional consequences and its negative impact on
men-
tal
health (Cordes & Dougherty, 1993; Maslach,
Schaufeli, & Leiter, 2001; Schaufeli &
Enzmann,
1998), recently accumulated evidence suggests that
it
also has a negative impact on physical health
and
may
be considered a risk factor for physical morbid-
ity
and bodily disorders. Thus, burnout and vital
exhaustion (a construct closely related to
burnout)
have been found in prospective studies to
predict
cardiovascular disease (CVD; Appels, 1988;
Appels
& Schouten, 1991a; Hallman, Thomsson, Burell,
Lis-
spers, & Setterlind, 2003), Type 2 diabetes
(Mel-
amed, Shirom, & Froom, 2003), impaired
fertility
(Sheiner, Sheiner, Carel, Potashnik, &
Shoham-
Vardi, 2002), and poor self-rated health
(Gorter,
Eijkman, & Hoogstraten, 2000; Halford,
Anderzen,
& Arnetz, 2003; Kahill, 1988).
Past studies have explored possible mediators of
the
relationships between burnout and physical mor-
bidity. These include atherogenic lipid profile
and
fasting glucose levels (Melamed, Kushnir, &
Shirom,
1992; Shirom, Westman, Shamai, & Carel,
1997),
sleep disturbances (Appels & Schouten,
1991b;
Grossi, Perski, Evengard, Blomkvist, &
Orth-Gomer,
2003; Melamed et al., 1999), and adverse health
behaviors, including smoking, lack of exercise,
and
excessive calorie intake (Gorter et al., 2000;
Mel-
amed et al., 1992; Schaufeli & Enzmann, 1998).
Our
study focused on the inflammatory process as a
pos-
sible mechanism (see rationale below) and
investi-
gated whether symptoms of burnout are associated
with two inflammatory biomarkers: C-reactive
pro-
tein (CRP) and fibrinogen.
Sharon Toker and Arie Shirom, Faculty of
Management,
Tel
Aviv University, Tel Aviv, Israel; Itzhak Shapira and
Shlomo Berliner, Department of Medicine D and
Institute
for
Special Medical Examinations (MALRAM), Tel Aviv
Sourasky Medical Center, Tel Aviv, Israel; Samuel
Mel-
amed, Department of Psychology, National Institute of
Oc-
cupational & Environmental Health, Raanana, Israel
and
Sackler School of Medicine, Tel-Aviv University.
This study was supported by Israel Science
Foundation
Grant 962/02–1 and by the Preventive Activities Program
of
the
Ministry of Labor and Social Welfare of the Govern-
ment of Israel.
We
thank Anat Mike, Roni Zamishlani, Shani Shenhar,
and
Nili Sofer for their valuable assistance throughout
this
project.
Correspondence concerning this article should be
ad-
dressed to Sharon Toker or Arie Shirom, Faculty of
Man-
agement, Tel Aviv University, Tel Aviv, Israel.
E-mail:
tokersha@post.tau.ac.il or
ashirom@post.tau.ac.il
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