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

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.

Reduced self-regulation mirrors the distorting effects of burnout symptomatology on task difficulty perception during an inhibition task

“…Interestingly, we did not find associations between resting vagally mediated HRV and burnout symptomatology. The results of the few existing previous studies investigating this association have been inconclusive with some evidence suggesting reductions in vagally mediated HRV associated with the MBI total score (de Vente, van Amsterdam, Olff, Kamphuis, & Emmelkamp, 2015), while others have reported no association (Jönsson et al, 2015;van Doornen et al, 2009;Zanstra, Schellekens, Schaap, & Kooistra, 2006) or only with respect to specific sub-dimensions of this measure (Kanthak et al, 2017). Based on this small number of studies it would be premature to draw conclusions on burnout-associated modulations in vagal function.…”

Is There an Optimal Autonomic State for Enhanced Flow and Executive Task Performance?

“…Recent public health focus on occupational burnout and stress resiliency has prompted further investigation into the role of the autonomic system in cognitive performance. Increasing number of recent studies have suggested that burnout is related to autonomic dysfunction during excessive stress (Lennartsson et al, 2016; Kanthak et al, 2017; May et al, 2018; Zhang et al, 2018; Traunmuller et al, 2019). However, despite these concerning observations, the effects of autonomic state on cognitive performance have not been fully defined, and some degree of increased stress may actually be desired for task performance.…”

Heart rate variability and salivary cortisol in very preterm children during school age

“…In particular, children born very preterm are endowed with immature organs and are exposed to several illness-related adversities and invasive treatments Roberts and Dalziel, 2006). Later in their lives, very preterm children are more likely to suffer from physical disorders and psychological disturbances, such as depression, burnout, and anxiety disorders (Aarnoudse-Moens et al, 2009;Aylward, 2005;, which, in turn, may be associated with alterations in autonomic function (Kanthak et al, 2017;Licht et al, 2008;van Gestel and Steier, 2011). Compared to their peers born at term, infants born preterm show decreased HRV right after birth and at theoretical term (Landrot et al, 2007;Patural et al, 2008).…”