Is burnout a depressive disorder? A re-examination with special focus on atypical depression

Whether burnout and depression cover the same psychopathology remains to be elucidated. To date, subtypes of depression have been overlooked in research on the burnout–depression overlap. Our aim was to estimate the prevalence of depressive disorders in workers with burnout while examining the overlap of burnout with the atypical subtype of depression. The present study included 5,575 schoolteachers (mean age = 41 years; 78% female). Burnout was assessed with the Maslach Burnout Inventory. Depression was measured with the 9-item depression scale of the Patient Health Questionnaire (PHQ-9). Atypical features of depression were examined using a dedicated module, referenced to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). We found that 90% of the teachers identified as burned out met diagnostic criteria for depression. Among them, 92% scored 15 or higher on the PHQ-9, a threshold at which active treatment with pharmacotherapy and/or psychotherapy is recommended. The features of atypical depression were observed in 63% of the burned-out participants with major depression. Emotional exhaustion, the hallmark of burnout, was more strongly associated with depression than with depersonalization and reduced personal accomplishment, the 2 other putative dimensions of burnout. The present study suggests that the burnout–depression overlap has been largely underestimated. Atypical depression may account for a substantial part of this overlap. Overall, our findings point to depressive symptoms and depressive disorders as central concerns in the management of burnout. The clinical research on treatments for depression offers solutions that may help workers identified as burned out.