Burnout symptom sub-types and cortisol profiles: what's burning most?

The current study assessed which specific burnout symptoms were most predictive of distinct diurnal cortisol profiles. Participants included 401 day-shift workers employed in a random sampling of 34 Canadian workplaces. The 16-item Maslach Burnout Inventory was used to extract burnout sub-scales that included emotional exhaustion, cynicism, professional inefficacy, as well as a global burnout average. Consenting workers provided five saliva samples a day (awaking, 30 min after awaking, 1,400 h, 1,600 h, and bedtime) repeated three times over the course of a week (Saturday, Tuesday, Thursday) to capture workday and non-workday variations. Multilevel regression models were estimated from cortisol measurements at each occasion within a day at level-1, workers at level-2, and workplaces at level-3. Multilevel regression analyses found that emotional exhaustion and a global burnout showed the strongest and consistent negative associations to cortisol in the afternoon and evening. In a separate analysis using regression coefficients, emotional exhaustion and a global burnout average were associated with low cortisol levels 30 min upon awakening. By contrast, professional inefficacy was associated only with lower bedtime cortisol. No associations were detected for cynicism and sex did not emerge as a moderator in secondary analyses. Our findings are discussed in a theoretical framework postulating different pathophysiological stages of burnout development. Specifically, professional inefficacy may be the earliest warning signal culminating with emotional exhaustion that may dampen diurnal cortisol levels.