Dr. Don Deems, the Dentist's Coach - Free Newsletter: Job Strain, Burnout, and Depression: Know This!

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Job Strain, Burnout, and Depression: Know This!
June 01, 2009

Every high-performing dentist I know works just as hard - or even harder - than glamorous multi-million dollar athletes. Yet, our job isn't so glamorous most of the time, is it? Some make it look easy, but what's behind their success and ability is something they just didn't get by showing up at the office every day.

Of course, there are pluses - and minuses - for being that "multi-million dollar athlete". As dentists, we are especially prone to high levels of job strain, and we are at increased risk of burnout.

Occupations like ours - high stress and strain - seem to explain the relationship between job strain and depression, as a study in the Journal of Occupational and Environmental Medicine reported. In this study, a specific questionnaire was used to assess burnout and job strain in a representative sample of 3,270 Finnish workers. Workers with high scores for exhaustion and cynicism and low scores for professional effectiveness were considered to have burnout.

High job strain was defined as facing high work demands with little control over one's work. The workers were also assessed for symptoms of depression. Twenty-eight percent of workers met the study definition of burnout. High alcohol use, physical inactivity, being overweight, and having a physical or mental illness also increased the risk of burnout.

High job strain was present in 23 percent of workers, and was the most important risk factor for burnout. After adjustment for other factors, workers with high job strain were seven times more likely to be "burned out" than those with low job strain. Are you with me?

High job strain was also the strongest risk factor for depression. Workers with high job strain were four times more likely to have depressive symptoms and 70 percent more likely to score in the "clinically depressed" range. Do I have your attention? The relationship between job strain and burnout was little affected by adjustment for other factors, including indicators of physical and mental health. In contrast, the association between job strain and depression all but disappeared after adjustment for burnout. This suggests that much of the association between job strain and depression is attributable to burnout.

Burnout and depression were also related to other categories of job strain: "active work," consisting of high job demands and high control; and "passive work," with low demands and low control. The concept of job burnout - defined as "a state of exhaustion combined with doubts about the value of one's own work and competence" - is still debated among occupational health researchers. Previous studies have shown a close relationship between burnout, which is supposedly work-related and depression, generally regarded as a more pervasive problem. The new study is the first that simultaneously assessed all three factors in a large population representing the full range of occupations.

Although the study can't prove any cause-and-effect relationship, the results suggest that burnout is an intermediate step in the relationship between job strain and depression. It also suggests that various types of job strain may contribute to burnout.

So what about us dentists? Does this really apply to us? You bet!

A large percentage of my clients report that stress at the workplace is high - in some cases, very high - and this bleeds into their life at home and with their family. They notice being snappy with staff members, and giving patients less of their attention than what is needed to get through an appointment. As a result, staff morale suffers and patients become less-than-enthusiastic about completing elective treatment and referring patients. Spousal relationships can become tense; divorce sometimes follows. You can bet there's more.

An exhaustive study of over 5,000 dentists completed by our own ADA came to similar conclusions of the study I mentioned earlier, in case you're wondering.

There is hope for us dentists. There is a way out, and a way to stay out. Start with these few tips, then build on them:

1. Give yourself a break. Face it, what we do is tough, day in and day out, and we have everything on our shoulders. Begin acknowledging yourself as that "million-dollar athlete" and start taking care of yourself as if you were.

2. Learn how to influence what you can - and let go of the rest. By now you know that control is an illusion, so quit trying to control everything. It'll kill you.

3. Pay attention to what you need to be able to work in peak performance each day. Some of us go without food or bathroom breaks for extended periods. Some of us never take any time off for relaxation or doing something we enjoy. The list goes on. Do it now - life is short.

4. Don't try to do everything alone. I know, you're a million-dollar athlete, but do you know what the million-dollar athletes do to maintain peak performance? Think about it. For one, they have a COACH.

5. If you're experiencing symptoms of depression or anxiety that is interfering with life, get help. Educate yourself about these ailments, because they ARE a result of the stress that we face. (Yes, there are other factors.) My experience with people who finally get medical attention is that they feel like a veil has been lifted away from them. The stress has been so heavy for so long ... They are then free to change their life and work, and many go on to later reduce or eliminate their need for medical help.

It's my hope that if you're reading this and feeling overwhelmed with everything that's required of you, that you'll give me a call. Together, we can work it out.

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