Job strain, burnout, and depressive symptoms: A prospective study among dentists

Background: Burnout has been presented as an antecedent of depression, but longitudinal data are lacking. We investigated whether burnout mediates the association between job strain and depressive symptoms. Methods: Two surveys were conducted. In 2003, 71% of Finnish dentists were reached, and the response rate of the 3-year follow-up was 84% (n=2555). Burnout was measured with the Maslach Burnout Inventory and depressive symptoms with the Beck Depression Inventory. The sequences 'job strain-burnout-depressive symptoms' and 'job strain-depressive symptoms-burnout' were investigated with logistic regression analyses. Results: Of the burnout sufferers without depressive symptoms at baseline, 23% reported depressive symptoms at follow-up. The adjusted odds ratio of burnout for depressive symptoms was 2.6 (95% CI 2.0-3.5). The effect of job strain on depressive symptoms had an OR of 3.4 (95% CI 2.0-5.7), but it disappeared when adjusted for burnout. Of those who had depressive symptoms without burnout at baseline, 63% had burnout at follow-up. The adjusted odds ratio of depressive symptoms for burnout was 2.2 (95% CI 1.4-3.4). The effect of job strain on burnout had an OR of 27.9 (95% CI 6.5-120.2) for the men and 4.9 (95% CI 2.5-9.6) for the women. These effects remained significant after adjustment for depressive symptoms. Limitations: The study was conducted among one occupational group. Conclusions: There is a reciprocal relationship between burnout and depressive symptoms. Job strain predisposes to depression through burnout. In comparison, job strain predisposes to burnout directly and via depression. (c) 2007 Elsevier B.V. All rights reserved.