Physicians assessing people at-risk for cardiovascular disease should consider work-related burnout in addition to the traditional risk factors, suggests a research review published in May’s Psychological Bulletin (Vol. 132, No. 3). The recommendation stems from an analysis of dozens of studies that converge on the idea that burnout—defined as persistent emotional exhaustion, physical fatigue and cognitive weariness—may negatively affect workers’ physical health more than previously believed.

In fact, recent research has found that burnout—and the related concept of “vital exhaustion”—increases the risk for cardiovascular disease as much as such well-known risk factors as body mass index, smoking and lipid levels. Specifically, burnout increases people’s likelihood of developing myocardial infarction, ischemic heart disease, stroke and sudden cardiac death. Studies also point to an increased likelihood of type II diabetes, male infertility, sleep disorders and musculoskeletal disorders among those with the extreme physical, mental and emotional fatigue.

The review, written by psychology professor Samuel Melamed, PhD, and his colleagues at Tel-Aviv University in Israel, sheds light on how burnout contributes to poor health outcomes. One possible culprit: Many studies show that burned-out workers have lower cortisol levels than their peers. Because cortisol helps restrain activation of the immune system and other components of the stress response, a deficit may disinhibit immune function, leading to hyperactivity of innate immune inflammatory responses.

“There is an increased recognition in the literature that inflammatory processes are central to the pathogenesis of chronic diseases, including cardiovascular disease, diabetes and cancer,” Melamed explains.

Other potential pathways between burnout and health problems could include poor health behaviors, sleep disturbances, the metabolic syndrome and difficulty breaking down blood proteins that contribute to clotting.

Moreover, some research suggests that burnout’s persistence over time may arise from a vicious cycle in which its physiological affects—such as increased concentrations of proinflammatory cytokines—feed back into the brain, further contributing to workers’ exhaustion and weariness.

Interventions that target only one aspect of burnout—such as by ramping up workers’ coping skills without addressing chronic inflammation and other physical effects—are less likely to break the burnout cycle, Melamed suggests. Indeed, the complicated nature of burnout calls for multidisciplinary interventions addressing organizational, behavioral, psychological and physiological factors, the authors conclude.

—D. Smith Bailey