Skip to main content
PMC home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2000 Jul;57(7):453–457. doi: 10.1136/oem.57.7.453

Relation between immune variables and burnout in a sample of physicians

A Bargellini 1, A Barbieri 1, S Rovesti 1, R Vivoli 1, R Roncaglia 1, P Borella 1
PMCID: PMC1739992  PMID: 10854497

Abstract

OBJECTIVES—To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables.
METHODS—Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures.
RESULTS—With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables.
CONCLUSIONS—In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.


Keywords: burnout; physicians; immune variables

Full Text

The Full Text of this article is available as a PDF (144.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ader R., Cohen N., Felten D. Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet. 1995 Jan 14;345(8942):99–103. doi: 10.1016/s0140-6736(95)90066-7. [DOI] [PubMed] [Google Scholar]
  2. Ader R., Cohen N. Psychoneuroimmunology: conditioning and stress. Annu Rev Psychol. 1993;44:53–85. doi: 10.1146/annurev.ps.44.020193.000413. [DOI] [PubMed] [Google Scholar]
  3. Atance Martínez J. C. Aspectos epidemiológicos del síndrome de "burnout" en personal sanitario. Rev Esp Salud Publica. 1997 May-Jun;71(3):293–303. [PubMed] [Google Scholar]
  4. Bellani M. L., Furlani F., Gnecchi M., Pezzotta P., Trotti E. M., Bellotti G. G. Burnout and related factors among HIV/AIDS health care workers. AIDS Care. 1996 Apr;8(2):207–221. doi: 10.1080/09540129650125885. [DOI] [PubMed] [Google Scholar]
  5. Borella P., Bargellini A., Rovesti S., Pinelli M., Vivoli R., Solfrini V., Vivoli G. Emotional stability, anxiety, and natural killer activity under examination stress. Psychoneuroendocrinology. 1999 Aug;24(6):613–627. doi: 10.1016/s0306-4530(99)00016-5. [DOI] [PubMed] [Google Scholar]
  6. Borella P., Bargellini A., Salvioli S., Cossarizza A. Use of flameless atomic absorption spectroscopy in immune cytolysis for nonradioactive determination of killer cell activity. Clin Chem. 1996 Feb;42(2):319–325. [PubMed] [Google Scholar]
  7. Borella P., Bargellini A., Salvioli S., Medici C. I., Cossarizza A. The use of non-radioactive chromium as an alternative to 51Cr in NK assay. J Immunol Methods. 1995 Oct 12;186(1):101–110. doi: 10.1016/0022-1759(95)00140-6. [DOI] [PubMed] [Google Scholar]
  8. Catalan J., Burgess A., Pergami A., Hulme N., Gazzard B., Phillips R. The psychological impact on staff of caring for people with serious diseases: the case of HIV infection and oncology. J Psychosom Res. 1996 Apr;40(4):425–435. doi: 10.1016/0022-3999(95)00527-7. [DOI] [PubMed] [Google Scholar]
  9. Christensen A. J., Edwards D. L., Wiebe J. S., Benotsch E. G., McKelvey L., Andrews M., Lubaroff D. M. Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility. Psychosom Med. 1996 Mar-Apr;58(2):150–155. doi: 10.1097/00006842-199603000-00009. [DOI] [PubMed] [Google Scholar]
  10. Corrigan P. W., Holmes E. P., Luchins D. Burnout and collegial support in state psychiatric hospital staff. J Clin Psychol. 1995 Sep;51(5):703–710. doi: 10.1002/1097-4679(199509)51:5<703::aid-jclp2270510516>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  11. Deary I. J., Blenkin H., Agius R. M., Endler N. S., Zealley H., Wood R. Models of job-related stress and personal achievement among consultant doctors. Br J Psychol. 1996 Feb;87(Pt 1):3–29. doi: 10.1111/j.2044-8295.1996.tb02574.x. [DOI] [PubMed] [Google Scholar]
  12. Deckard G., Meterko M., Field D. Physician burnout: an examination of personal, professional, and organizational relationships. Med Care. 1994 Jul;32(7):745–754. doi: 10.1097/00005650-199407000-00007. [DOI] [PubMed] [Google Scholar]
  13. Fields A. I., Cuerdon T. T., Brasseux C. O., Getson P. R., Thompson A. E., Orlowski J. P., Youngner S. J. Physician burnout in pediatric critical care medicine. Crit Care Med. 1995 Aug;23(8):1425–1429. doi: 10.1097/00003246-199508000-00018. [DOI] [PubMed] [Google Scholar]
  14. Goldberg R., Boss R. W., Chan L., Goldberg J., Mallon W. K., Moradzadeh D., Goodman E. A., McConkie M. L. Burnout and its correlates in emergency physicians: four years' experience with a wellness booth. Acad Emerg Med. 1996 Dec;3(12):1156–1164. doi: 10.1111/j.1553-2712.1996.tb03379.x. [DOI] [PubMed] [Google Scholar]
  15. Guntupalli K. K., Fromm R. E., Jr Burnout in the internist--intensivist. Intensive Care Med. 1996 Jul;22(7):625–630. doi: 10.1007/BF01709737. [DOI] [PubMed] [Google Scholar]
  16. Harrington J. M., Calvert I. A. Research priorities in occupational medicine: a survey of United Kingdom personnel managers. Occup Environ Med. 1996 Sep;53(9):642–644. doi: 10.1136/oem.53.9.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Herbert T. B., Cohen S. Stress and immunity in humans: a meta-analytic review. Psychosom Med. 1993 Jul-Aug;55(4):364–379. doi: 10.1097/00006842-199307000-00004. [DOI] [PubMed] [Google Scholar]
  18. Houtman I. L., Goudswaard A., Dhondt S., van der Grinten M. P., Hildebrandt V. H., van der Poel E. G. Dutch monitor on stress and physical load: risk factors, consequences, and preventive action. Occup Environ Med. 1998 Feb;55(2):73–83. doi: 10.1136/oem.55.2.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Humphris G., Lilley J., Kaney S., Broomfield D. Burnout and stress-related factors among junior staff of three dental hospital specialties. Br Dent J. 1997 Jul 12;183(1):15–21. doi: 10.1038/sj.bdj.4809420. [DOI] [PubMed] [Google Scholar]
  20. Iacovides A., Fountoulakis K., Moysidou C., Ierodiakonou C. Burnout in nursing staff: a clinical syndrome rather than a psychological reaction? Gen Hosp Psychiatry. 1997 Nov;19(6):419–428. doi: 10.1016/s0163-8343(97)00070-4. [DOI] [PubMed] [Google Scholar]
  21. Jung W., Irwin M. Reduction of natural killer cytotoxic activity in major depression: interaction between depression and cigarette smoking. Psychosom Med. 1999 May-Jun;61(3):263–270. doi: 10.1097/00006842-199905000-00002. [DOI] [PubMed] [Google Scholar]
  22. Kemeny M. E., Cohen F., Zegans L. S., Conant M. A. Psychological and immunological predictors of genital herpes recurrence. Psychosom Med. 1989 Mar-Apr;51(2):195–208. doi: 10.1097/00006842-198903000-00008. [DOI] [PubMed] [Google Scholar]
  23. Kirwan M., Armstrong D. Investigation of burnout in a sample of British general practitioners. Br J Gen Pract. 1995 May;45(394):259–260. [PMC free article] [PubMed] [Google Scholar]
  24. Knoop R. Relieving stress through value-rich work. J Soc Psychol. 1994 Dec;134(6):829–836. doi: 10.1080/00224545.1994.9923017. [DOI] [PubMed] [Google Scholar]
  25. Koh K. B., Lee B. K. Reduced lymphocyte proliferation and interleukin-2 production in anxiety disorders. Psychosom Med. 1998 Jul-Aug;60(4):479–483. doi: 10.1097/00006842-199807000-00015. [DOI] [PubMed] [Google Scholar]
  26. Nakamura H., Nagase H., Yoshida M., Ogino K. Natural killer (NK) cell activity and NK cell subsets in workers with a tendency of burnout. J Psychosom Res. 1999 Jun;46(6):569–578. doi: 10.1016/s0022-3999(99)00009-4. [DOI] [PubMed] [Google Scholar]
  27. O'Leary A. Stress, emotion, and human immune function. Psychol Bull. 1990 Nov;108(3):363–382. doi: 10.1037/0033-2909.108.3.363. [DOI] [PubMed] [Google Scholar]
  28. Piedmont R. L. A longitudinal analysis of burnout in the health care setting: the role of personal dispositions. J Pers Assess. 1993 Dec;61(3):457–473. doi: 10.1207/s15327752jpa6103_3. [DOI] [PubMed] [Google Scholar]
  29. Prosser D., Johnson S., Kuipers E., Szmukler G., Bebbington P., Thornicroft G. Mental health, "burnout' and job satisfaction among hospital and community-based mental health staff. Br J Psychiatry. 1996 Sep;169(3):334–337. doi: 10.1192/bjp.169.3.334. [DOI] [PubMed] [Google Scholar]
  30. Ramirez A. J., Graham J., Richards M. A., Cull A., Gregory W. M. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996 Mar 16;347(9003):724–728. doi: 10.1016/s0140-6736(96)90077-x. [DOI] [PubMed] [Google Scholar]
  31. Scanlan J. M., Vitaliano P. P., Ochs H., Savage M. V., Borson S. CD4 and CD8 counts are associated with interactions of gender and psychosocial stress. Psychosom Med. 1998 Sep-Oct;60(5):644–653. doi: 10.1097/00006842-199809000-00023. [DOI] [PubMed] [Google Scholar]
  32. Schedlowski M., Jacobs R., Alker J., Pröhl F., Stratmann G., Richter S., Hädicke A., Wagner T. O., Schmidt R. E., Tewes U. Psychophysiological, neuroendocrine and cellular immune reactions under psychological stress. Neuropsychobiology. 1993;28(1-2):87–90. doi: 10.1159/000119006. [DOI] [PubMed] [Google Scholar]
  33. Turnipseed D. L. Anxiety and burnout in the health care work environment. Psychol Rep. 1998 Apr;82(2):627–642. doi: 10.2466/pr0.1998.82.2.627. [DOI] [PubMed] [Google Scholar]
  34. Visintini R., Campanini E., Fossati A., Bagnato M., Novella L., Maffei C. Psychological stress in nurses' relationships with HIV-infected patients: the risk of burnout syndrome. AIDS Care. 1996 Apr;8(2):183–194. doi: 10.1080/09540129650125867. [DOI] [PubMed] [Google Scholar]
  35. Watson P., Feld A. Factors in stress and burnout among paediatric nurses in a general hospital. Nurs Prax N Z. 1996 Nov;11(3):38–46. [PubMed] [Google Scholar]
  36. Woodward C. A., Shannon H. S., Cunningham C., McIntosh J., Lendrum B., Rosenbloom D., Brown J. The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study. Med Care. 1999 Jun;37(6):556–569. doi: 10.1097/00005650-199906000-00005. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES