Burnout Syndrome As an Occupational Disease in the European Union: an Exploratory Study
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160Industrial Health 2018, 56, 160–165 Short CommunicationA LASTOVKOVA et al. Burnout syndrome as an occupational disease in the European Union: an exploratory study Andrea LASTOVKOVA1, Melanie CARDER2, Hans Martin RASMUSSEN3, Lars SJOBERG4, Gerda J. de GROENE5, Riitta SAUNI6, Jiri VEVODA7, Sarka VEVODOVA7, Gerard LASFARGUES8, Magnus SVARTENGREN9, Marek VARGA10, Claudio COLOSIO11 and Daniela PELCLOVA1* 1Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic 2Centre of Occupational and Environmental Health, University of Manchester, United Kingdom 3National Board of Industrial Injuries, Department of Statistics, Denmark 4Functional Impairment Department, Swedish Social Insurance Agency, Sweden 5Netherlands Centre for Occupational Diseases, Department Coronel Institute of Occupational Health, Academic Medical Center, The Netherlands 6Ministry of Social Affairs and Health, Department for Occupational Safety and Health, Finland 7Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacky University Olomouc, Czech Republic 8Institute of Occupational Health, University of Paris-Est Créteil, France 9Occupational Environmental Medicine, Department of Medical Sciences, Uppsala University, Sweden 10Department of Occupational Medicine and Clinical Toxicology, Medical Faculty of P. J. Šafarik University and University hospital of Louis Pasteur, Slovakia 11Department of Health Sciences of the University of Milano and International Centre for Rural Health of the San Paolo Hospital, Italy Received August 3, 2017 and accepted October 27, 2017 Published online in J-STAGE November 3, 2017 Abstract: The risk of psychological disorders influencing the health of workers increases in accor- dance with growing requirements on employees across various professions. This study aimed to compare approaches to the burnout syndrome in European countries. A questionnaire focusing on stress-related occupational diseases was distributed to national experts of 28 European Union coun- tries. A total of 23 countries responded. In 9 countries (Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden) burnout syndrome may be acknowledged as an occu- pational disease. Latvia has burnout syndrome explicitly included on the List of ODs. Compensation for burnout syndrome has been awarded in Denmark, France, Latvia, Portugal and Sweden. Only in 39% of the countries a possibility to acknowledge burnout syndrome as an occupational disease exists, with most of compensated cases only occurring in recent years. New systems to collect data on suspected cases have been developed reflecting the growing recognition of the impact of the psycho- social work environment. In agreement with the EU legislation, all EU countries in the study have an action plan to prevent stress at the workplace. Key words: Burnout syndrome, Occupational diseases, Psychosocial stress, Mental disorders, Compen- sation, Prevention *To whom correspondence should be addressed. E-mail: [email protected] ©2018 National Institute of Occupational Safety and Health This is an open-access article distributed under the terms of the Creative Commons Attribution Non-CommercialIndustrial No Derivatives Health 2018,(by-nc-nd) 56 ,License. 160–165 BURNOUT SYNDROME AS AN OCCUPATIONAL DISEASE IN EUROPE 161 In parallel with growing high demands on employees services; some studies also concern lawyers, managers, across all occupations the negative influence on workers’ etc., who however are less involved9). Based on data col- mental health is continuously rising and chronic stress- lected by The Health and Occupation Research (THOR) related occupational diseases, especially burnout syn- Network in the UK, a national occupational health surveil- drome, are becoming an important issue1, 2). lance scheme utilising voluntary data reported by medical The ILO/WHO List of occupational diseases (ODs) experts (including psychiatrists and occupational physi- revised in 2010, which serves as an example for all coun- cians), workload and communication difficulties with other tries in the world, includes in the Chapter 2.4, among the workers seem to represent the most significant risk factors ”Mental and behavioural disorders”, the “Post-traumatic for developing work-related mental health problems10). stress disorder and additional mental or behavioural dis- The reason why it is difficult to prevent stress in the orders not mentioned”. On the other hand, the European workplace is also the problem of its evaluation. The level Commission Recommendation (EC 2003) concerning the of stress varies with the type of job, and its perception is European Schedule of ODs does not include any stress- considerably subjective. Karasek’s Job strain model uses induced disorder. However, in several countries, there is structured questionnaires and deals with two aspects, such a possibility to update the List of ODs and criteria of the as “demands” and “decision latitude”. Subjects with high diseases3, 4). demands and low decision latitude are the most strained The term “burnout” was first used in 1974 by and at the highest risk of developing stress related dis- Freudenberger in his study called “Staff burnout”. Shortly orders11). According to Siegrist’s effort-reward imbal- after that, in 1976, burnout syndrome was defined by ance model, the most stressful condition occurs when the Maslach and Jackson as a three dimensional syndrome reward does not match the effort made12). Recent review on characterized by exhaustion, cynicism and inefficacy, i.e. the job stress models showed the highest value for predict- the opposite to engagement, described as energy, involve- ing burnout syndrome of following models: the Job Strain ment and efficacy5). Burnout syndrome prevention has Model and the Effort/Reward Imbalance Model (which been discussed worldwide due to the economic burden of were the most used and whether used in combination most the absenteeism and other negative consequences related effective), the Mediation Model of Maslach and Leiter, to job satisfaction, work performance and patient care. and other new models, such as the Job Demand Resources According to Kissling et al., the German yearly average Model and the Demand Induced Strain Compensation number of sick days attributed to burnout rose from 0.67 model. in 2004 to 9.1 d in 2011, i.e. 14 times6). In the Netherlands, The latest revision of the International Classification about 15% of sickness absence of the working population of diseases (ICD-10) does not denominate burnout syn- was caused by burnout and the annual cost of this disorder drome as an individual diagnosis. Burnout syndrome reached 1.7 billion Euros in 20057). is listed as an additional diagnosis under Chapter XXI - Nowadays, there is no doubt that burnout syndrome Problems related to life-management difficulty, coded as Z can be caused and/or aggravated by work and it is very 73.0 (State of vital exhaustion). Similarly, the Diagnostic important to diagnose it early and introduce preventive and Statistical Manual of Mental Disorders, Fifth Edition measures. About 8% of the German working population (DSM-5), i.e. the 2013 update to the American Psychiatric believe they suffer from burnout syndrome6). In a study Association, does not include burnout syndrome. Accord- among 7 400 Czech physicians, 34% feel that they already ing to some specialists, burnout syndrome is simply a state show symptoms of burnout and 83% perceive themselves of emotional and physical exhaustion which to a great to be at a risk of it8). Differences among various special- extent overlaps with depression. However, most research- ists were seen, the highest risk being found among trauma- ers believe that burnout should be better considered as a tologists, hemodialysis workers, infectionists, internists, work-related disorder13). gynaecologists, radiologists and surgeons. Interestingly, in This study aims to map the evaluation systems of burn- this study, occupational physicians stood at the other side out syndrome in the countries of the European Union (EU), of the scale with the smallest proportion of physicians with possible compensation of this disorder, and preventive burnout syndrome. measures used. It was agreed by the Charles University Most exposed occupations are the helping professions Review Board and supported by the institutional grants. such as health care workers, social workers, police offi- Occupational health specialists from all 28 EU coun- cers, and teachers and high touch jobs such as customer tries were contacted electronically and asked to complete a 162 A LASTOVKOVA et al. Table 1. List of Occupational Diseases, possibility to acknowledge burnout syndrome as an occupational disease, evaluation criteria, numbers of compensated cases and preventive measures in 23 European countries Ref 14* [OD=Occupational Disease, NCOD=Netherlands’ Center for Occupational Diseases, NA=not applicable] Participation Action plan Possibility to No of subjects of employees Use of Existence No of to limit stress acknowledge with acknowl- to address psy- psychologists Country of List of Evaluation Criteria compensated at work (% burnout edged burnout chosocial risks (% establish- OD’s subjects (yr) establish- syndrome syndrome (yr) (% establish- ments)* ments)* ments)* Committee evaluation, associated with Depression (F 32.9, F 33.0), 738 592 Denmark YES YES, open item 51 77 38 adjustment disorder (F 43.2), anxiety