"Burnout" in a clinical research trial environment

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Introduction

Working in a clinical trial environment holds a unique set of strains and stressors, which are often underplayed as the context is considered tightly regulated with few medical emergencies.  Relentless deadlines, scarce resources and multifaceted job descriptions all contribute to the challenging nature of clinical trial work. The month of October (2015) is dedicated to Mental Health Awareness. GRN has chosen to focus on the syndrome of burnout as a means of identifying and supporting those who are struggling with the demands of clinical trial research. Burnout is particularly prevalent among Clinical Research Coordinators faced with overwhelming and diverse responsibilities. (Gwede, Johnson, Roberts, & Cantor, 2007). This article highlights the features of burnout, the associated risks and how to assist a team member with burnout.

What is burnout?

No clear definition of burnout exists. Many experts in the field of mental health agree that burnout is a psychological syndrome which develops as a consequence to working in a stressful environment and is comprised of certain clinical features which negatively impact on functioning, yet are not considered to be a mental illness. Burnout may form part of an existing mental illness such as major depressive disorder, although the presence of burnout does not imply that the individual is suffering from a mental illness.

 The term was previously limited to those in “helping/caring professions” e.g. nursing or teaching, but is now accepted to extend into most working environments. Work-specific stressors such as an excessive workload and conflict with colleagues are thought to contribute to the development of burnout. Burnout may manifest with both mental and physical symptoms, however, individuals should always be assessed by their general practitioner (GP) to ensure that an underlying illness is not missed and incorrectly labeled as being “burnt out”.

Am I burnt out?

Signs and symptoms of burnout

• Physical and emotional exhaustion
• Disengagement or detachment from the working environment
• Reduced personal accomplishments
• Cynical or critical attitude in the workplace
• Irritability or impatience with colleagues
• Difficulty concentrating
• Feeling listless
• Drop in work performance

Problems associated with burnout?

• Development of a mental illness e.g. depression and anxiety
• Absenteeism from work
• Physical health problems
• Substance abuse
• Great economic cost e.g. extended or excessive sick leave

Is burn out the same thing as depression? 

Certain symptoms may occur in both conditions e.g. low energy; poor concentration; physical exhaustion which may lead to an incorrect diagnosis and missed opportunity for treatment, often with serious consequences. It is essential that the individual is appropriately assessed by their GP to ensure that a diagnosis of major depressive disorder is not missed. Suicidal thoughts and behaviour are not considered to be features of burnout and require urgent medical attention and management.

What can I do if I identify a team member who has signs of burnout?

1. IDENTIFY those who may be at risk of burnout: (Awa, Plaumann, & Walter, 2010; Gwede et al., 2007)

1. Job dissatisfaction
2. High perceived daily workload
3. Imbalance between job demand and job skills
4. Lack of job control
5. Effort reward imbalance
6. Prolonged work stress
7. Low endurance personalities

1. PREVENT burnout with a combination of both person-directed (cognitive behavioural strategies e.g. coping skills) and organization-directed (e.g. task restructuring; adequate work evaluation and supervision) interventions.

1. SUPPORT peers and co-workers who are struggling with burnout. This includes: provision of time to attend medical appointments; matching skills and job demands; empowering individuals by involving them in decision making.

 How can I manage my work related stress better?

• Get moving. Adequate exercise is essential to physical and mental well-being
• Follow a nutritious diet
• Ensure sufficient rest and relaxation
• Maintain hobbies and interests outside of work
• Nurture relationships with loved ones
• Avoid excessive use of stimulants e.g. caffeine and alcohol
• Consider a course of therapy e.g. mindfulness

 Conclusion

The personal and economic costs of burnout are significant in the already tightly resourced clinical trial research setting. Ensuring a supportive and healthy psychological working environment is essential to prevent burnout amongst clinical trial team members.

Author information

Dr Carla Freeman is a specialist psychiatrist, within the Division of Neuropsychiatry (Department of Psychiatry and Mental Health) at the Univeristy of Cape Town.