The causal links between stress and burnout in a longitudinal study of UK doctors
Abstract
Burnout and stress are common, linked problems in health-care workers. We aimed to clarify their causal associations. We assessed stress and the three components of burnout (emotional exhaustion, depersonalisation, and low personal accomplishment) using structural equation modelling in a 3-year longitudinal study of a representative sample of 331 UK doctors. Emotional exhaustion and stress showed reciprocal causation: high levels of emotional exhaustion caused stress (beta=0 189), and high levels of stress caused emotional exhaustion (beta=0 175). High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105).
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A three-year longitudinal study of 331 doctors by McManus et al. supports rejecting a simple unidirectional link between stress and burnout.
“Another large-scale, longitudinal study of 331 doctors conducted over three years provides further evidence for rejecting the simple one-way relationship between stress and burnout (McManus, Winder & Gordon, 2002).”
From Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes (2017) · cites this paper as McManus, Winder & Gordon, 2002
Emotional exhaustion and stress were found to cause each other.
“Instead, emotional exhaustion and stress demonstrated reciprocal causation.”
From Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes (2017) · cites this paper as McManus et al., 2002
Lower personal accomplishment predicted more stress, while greater depersonalization predicted less stress.
“Moreover, low levels of personal accomplishment led to increased levels of stress, whereas high levels of depersonalization led to decreased levels of stress.”
From Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes (2017) · cites this paper as McManus et al., 2002
Stress measures immediate reactions to stressors, while burnout measures chronic reactions to them.
“Stress is intended to measure the immediate effect of stressors on the individual, whereas burnout is intended to measure the chronic effect of such stressors.”
From Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes (2017) · cites this paper as McManus et al., 2002
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Stress and burnout among hemodialysis nurses: A single-center, prospective survey study
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- Authors
- McManus, I., Winder, B., & Gordon, D.
- Affiliations
- University College London (GB)
- The Royal Free Hospital (GB)
- Corresponding author
- McManus, IC
- ORCID
- McManus, IC
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2002-06
- Volume
- 359
- Issue
- 9323
- Pages
- 2089-2090
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2020710864
- Cited by
- 376
- References
- 6
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 13 · 2023: 23 · 2022: 26 · 2021: 31 · 2020: 27 · 2019: 23 · 2018: 20 · 2017: 25 · 2016: 11 · 2015: 17 · 2014: 21 · 2013: 11 · 2012: 16
- FWCI
- 21.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Nottingham Trent University's Institutional Repository (Nottingham Trent Repository) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- burnout, occupational stress, physicians, emotional exhaustion, depersonalization, personal accomplishment, reciprocal causation, healthcare workers, physician well-being
- MeSH terms
- Adult, Attitude of Health Personnel, Burnout, Professional, Family Practice, Female, United Kingdom, Humans, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, Incidence
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