his is the first part of a two-part blog post by WorkCare Associate Medical Director Brittany Busse, M.D.

It’s no wonder job burnout is trending on social media and being discussed at occupational health and safety conferences.

The World Health Organization (WHO) recently expanded on its definition of occupational burnout as a syndrome (not as a medical condition) in the International Classification of Diseases 11^th Revision (ICD-11), the global gold standard for diagnostic information. In ICD-11, the WHO defines job burnout as:

“A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

It lists three related characteristics:

• Feelings of energy depletion or exhaustion
• Increased mental distance from one’s job, or feelings of negativism or cynicism toward one’s job
• Reduced professional efficacy

According to a WHO statement: “Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” In an interesting related development, the organization reports it plans to embark on the development of evidence-based guidelines on mental well-being in the workplace.

Underlying Causes

The underlying causes of occupational burnout symptoms are not well-understood. However, many researchers believe burnout syndrome is related to chronically elevated levels of the adrenal hormone cortisol, which eventually leads to adrenal fatigue and insensitivity of body tissues to cortisol.

Chronically elevated cortisol levels and cortisol insensitivity can lead to immune system and other body system dysfunctions that are associated with the development of conditions ranging from heart disease and stroke, to autoimmune disease and cancer. This suggests that occupational burnout is either a cause of disease or a disease in and of itself.

According to the WHO, other mental health diseases – such as anxiety, depression, and other adjustment and mood disorders – must be ruled out before a diagnosis of burnout can be made, indicating that these other conditions arise organically and cannot necessarily be blamed on occupational stress.

Cost of Burnout

We know that the cost of occupational burnout is high. It is believed to be especially prevalent in certain types of professions, including health care and public safety (e.g., medical, police, fire, emergency response and military personnel).

Among physicians alone, an estimated $4.6 billion in annual costs related to physician turnover and reduced clinical hours may be attributed to burnout in the U.S., according to a study published in Annals of Internal Medicine. Given the risk of occupational burnout among all types of professions, the costs to employers, employees and society, in general, may be incalculable.

Who is Responsible?

Considering that burnout is so costly in terms of financial loss, social consequences and personal well-being, it seems reasonable to ask the question: Whose responsibility is it is to manage an employee’s level of stress?

I answer this question in Part 2 of this blog post. I base my response on the assertion that occupational burnout syndrome is a cumulative trauma injury, and that it is both the employer’s and the employee’s responsibility to work together to prevent and effectively manage burnout symptoms.