Post-pandemic, more workers worldwide report suffering from burnout. Though still not recognized medically, it’s a warning beacon for employers and insurers alike.
In 1974, American psychologist Herbert Freudenberger was among the first to note the symptoms of ‘burnout’. It has subsequently been described as having three main components: emotional exhaustion, depersonalization, and low personal accomplishment.
The WHO recognized burnout as “an occupational phenomenon” in 2019 but it is not yet considered a medical condition. Regardless of designation, the insurance industry could see more disability claims arise due to stress, anxiety, and depression – all of which may stem from burnout.
What is burnout?
Burnout results from excessive long-term stress caused by workload pressure and is characterized by extreme tiredness and reduced ability to deal with negative emotions. Exhaustion is generally the first symptom, followed by detachment and negative reactions to the job, and feelings of inadequacy and failure. This can lead to absenteeism, intention to leave a role and employee turnover.
In the 11th version of the International Classification of Diseases (ICD-11), the WHO classified burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. Italian and Latvian legislation calls it “an occupational disease”, distinguished from depression and anxiety. Sweden has diagnosed “work-related neurasthenia”, characterized by mental and physical exhaustion, since 1997, while the Netherlands uses the term “overstrain” and recognizes it as a work-related disease. However, a reluctance to recognize a burnout diagnosis persists for fear of multiple disability cover claims.
Burnout is increasingly seen as separate from anxiety and depression, and diagnosis could allow insured lives to claim under the condition if they fail to meet a definition for other mental health disorders.
Incidence and prevalence
Burnout is prevalent among health workers, especially those in time-critical job roles. According to the U.S.-based Journal of Emergency Medical Services, two studies in 2021 showed that rates among emergency medical service providers averaged 15% to 40%, and were highest among more advanced emergency responders who worked long shifts.
Healthcare employment pressures escalated during the COVID-19 pandemic, with U.S. health workers reporting high rates of stress, exhaustion, sleep loss, anxiety, substance abuse and suicidal ideation. Between June and September 2020, 93% reported experiencing stress, 86% anxiety and 76% exhaustion and burnout. However, research suggests that a burnout diagnosis may be blurred by alternative or concurrent diagnoses of anxiety and/or depression.
It is difficult to estimate how many people are absent from work due to burnout, as many are unwilling to reveal the underlying cause of absenteeism. However, in Germany, where statutory health insurers use the ICD-10’s Z73.0 code ‘work determinants associated with burnout and effects of burnout’, the percentage of the population suffering from the condition increased from 0.7% in 2006 to 2.8% in 2016. Absence due to burnout rose from 16 days per 1,000 members in 2006 to 87.5 days in 2012 but declined to 67.3 days in 2015; this could have been driven partially by therapy provision from health insurers.
A Dutch study, meanwhile, showed that employees with a low burnout score have an average absence rate of around 2.5%, those with a mid-range score have an average rate of 5% and employees with a high score have an average rate of 25%.
Risks and protective factors
Despite a lack of medical evidence supporting a clinical diagnosis, workers are increasingly reporting burnout. Table 1, below, lists some of the factors influencing the risk of burnout and its prevention.
Table 1: Factors influencing burnout risk and prevention
So what are the resulting medical conditions? Exhaustion from mental stress can cause physical symptoms such as headaches, gastrointestinal disruption, muscle tension, and poor sleep quality and quantity. Consequences can also include poor eating habits, insomnia, increased substance use (such as smoking and drinking alcohol), chronic depression, suicidal ideation and suicide attempts.
A meta-analysis of 36 studies showed that burnout was a significant predictor of hypercholesterolemia, Type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries, and mortality below the age of 45 – all factors in life insurance assessment. It also revealed a link between burnout and insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental health disorders, and psychological ill health.
Biological mechanisms resulting from prolonged stress may impact physical health. Overactivation of vital functions such as heart rate and blood pressure can cause metabolism and immune system changes, resulting in susceptibility to infectious diseases, poor sleep patterns and poor health behaviors such as smoking and reduced physical activity.
Burnt-out workers also had more than twice the risk of developing musculoskeletal pain compared to those not reporting it, nearly double the risk of Type 2 diabetes, and a higher risk of coronary heart disease. Although burnout was a risk factor for increased mortality below age 45, this did not apply to those aged 45 and above.