Breaking Point

Foreword xi

About the Authors xiii

Preface xv

1 Occupational Depression 1

Brief History of Depression 1

"Depression is rage turned inward," Dr. Jennifer Melfi 5

Challenge to Freud's Explanation of Depression 6

Helplessness and Hopelessness 10

Early Linkages of Work to Psychological State 11

The Diagnosis of Depression 15

Another Way to Think About Depression 17

Assessing Depression in the Research Context 19

"The Stress of Life" 19

Stressful Life Events 21

The Demand-Control (DC) Model of Job Stress 27

A New Development: The Demand-Control-Support (DCS) Model of Job Stress 32

Reverse Causality 33

The Effort-Reward Imbalance (ERI) Model 45

Workplace Bullying 47

Underestimates 53

Conclusions 55

Postscript 56

References 57

2 Burnout 73

Herbert J. Freudenberger 74

Christina Maslach 76

Correlation Coefficients and Reliability Coefficients 78

The Foundations of Burnout 80 More on Discriminant Validity 87

Antecedents of Burnout 88

The Multiplication of Burnout Scales 89

Problems with Burnout Symptom Items That Are Synonymous 92

Burnout as a Diagnosis 93

Longitudinal Research on Adverse Working Conditions and Burnout 94

Conclusions 103

References 104

3 Burnout-Depression Overlap 111

The Idea of a Syndrome 113

First Look at Burnout-Depression Overlap 113

Burnout and Depression as Distinct Constructs 114

A Line of Research by Bianchi, Schonfeld, and Colleagues 116

Burnout and Depressive Cognition 121

Neurobiology of Burnout and Depression 123

Anxiety and Depressive Symptoms 124

The Occupational Depression Inventory 127

Other Studies That Bear on Burnout-Depression Overlap 131

Meta-analyses 133

Conclusions 137

References 141

4 The Stigma Attached to Burnout 153

Some Background Beliefs 154

What Empirical Research Indicates 155

Burnout Versus Depression 156

Destigmatizing Burnout 159

Conclusions 160

References 161

5 Interventions 165

Models of Interventions 165

Randomized Control Trials and Meta-analyses 168

Tertiary Interventions 173

Primary and Secondary Interventions for Depression, Psychological Distress, and Burnout 182

A Pertinent Primary Intervention Study 189

Conclusions 191

References 194

Appendix 203

Occupational Depression Inventory (ODI) 203

Inventaire de Depression Professionnelle (IDP) 205

Index 209