Burnout: A Review of Theory and Measurement
倦怠：理论与测量回顾

Abstract 抽象的

A growing body of empirical evidence shows that occupational health is now more relevant than ever due to the COVID-19 pandemic. This review focuses on burnout, an occupational phenomenon that results from chronic stress in the workplace. After analyzing how burnout occurs and its different dimensions, the following aspects are discussed: (1) Description of the factors that can trigger burnout and the individual factors that have been proposed to modulate it, (2) identification of the effects that burnout generates at both individual and organizational levels, (3) presentation of the main actions that can be used to prevent and/or reduce burnout, and (4) recapitulation of the main tools that have been developed so far to measure burnout, both from a generic perspective or applied to specific occupations. Furthermore, this review summarizes the main contributions of the papers that comprise the Special Issue on “Occupational Stress and Health: Psychological Burden and Burnout”, which represent an advance in the theoretical and practical understanding of burnout.
越来越多的经验证据表明，由于 COVID-19 大流行，职业健康现在比以往任何时候都更加重要。这篇评论的重点是职业倦怠，这是一种由工作场所的长期压力引起的职业现象。在分析了倦怠如何发生及其不同维度后，讨论了以下几个方面：（1）描述可以引发倦怠的因素以及已提出的调节倦怠的各个因素，（2）识别倦怠产生的影响个人和组织层面，(3) 介绍可用于预防和/或减少倦怠的主要行动，以及 (4) 从一般角度概括迄今为止已开发的衡量倦怠的主要工具或应用于特定职业。此外，这篇综述总结了“职业压力与健康：心理负担和倦怠”特刊中论文的主要贡献，这些论文代表了对倦怠的理论和实践理解的进步。

1. Introduction 一、简介

When work and professional environments are not well organized and managed, they can have adverse consequences for workers that, far from dignifying them, exhaust them and consume their psychological resources. Burnout has become one of the most important psychosocial occupational hazards in today’s society, generating significant costs for both individuals and organizations [1,2,3,4]. Although burnout was initially considered to be specific to professionals working in the care of people [5], later evidence has shown that this syndrome can develop among all types of professions and occupational groups [6,7]. However, burnout prevalence estimates vary considerably according to the burnout definition applied. For instance, a national study of US general surgery residents found estimates varied from 3.2% to 91.4%, with 43.2% of respondents acknowledging weekly symptoms [8].
当工作和专业环境组织和管理不善时，可能会给工人带来不利后果，不仅不能增强他们的尊严，反而会耗尽他们的精力并消耗他们的心理资源。倦怠已成为当今社会最重要的社会心理职业危害之一，给个人和组织带来巨大成本[1,2,3,4]。尽管职业倦怠最初被认为是专门针对从事护理工作的专业人员 [5]，但后来的证据表明，这种综合症可以在所有类型的专业和职业群体中出现 [6, 7]。然而，根据所采用的倦怠定义，倦怠发生率的估计值有很大差异。例如，一项针对美国普外科住院医师的全国性研究发现，估计值从 3.2% 到 91.4% 不等，其中 43.2% 的受访者承认每周都会出现症状 [8]。

The enormous negative impact that burnout has on the work and personal lives of workers, also affecting the economy and public health of the most affected countries, has led the World Health Organization (WHO) to include this syndrome in the 11th Revision of the International Classification of Diseases (ICD-11) as a phenomenon exclusive to the occupational context. Likewise, the need to address burnout is also justified for legal reasons, such as compliance with the European Union Framework Directive on Health and Safety (89/391/EEC).
职业倦怠对工人的工作和个人生活造成巨大负面影响，也影响受影响最严重国家的经济和公共卫生，导致世界卫生组织 (WHO) 将这种综合症纳入国际分类第十一版修订版疾病（ICD-11）作为一种职业环境独有的现象。同样，出于法律原因，也需要解决倦怠问题，例如遵守欧盟健康与安全框架指令 (89/391/EEC)。

A growing body of empirical evidence shows that occupational health is now more relevant than ever due to the COVID-19 pandemic. Particularly, the pandemic has placed considerable psychological strain on healthcare workers. Since the COVID-19 outbreak, numerous studies related to burnout have been carried out with samples of frontline healthcare workers, physicians, nurses, or pharmacists across the world [9,10,11,12]. However, the lack of a baseline level of burnout before the pandemic makes it difficult to compare changes in prevalence for the same populations. Evidence from studies of the impact of past outbreaks (e.g., SARS, influenza, or Ebola epidemics) show long-term cognitive and mental health effects (e.g., emotional distress, post-traumatic stress disorder) [13]. This evidence can be useful to design interventions for healthcare workers. These are also hard times for workers in general. Teleworking full-time due to COVID-19 has received the attention of several empirical works, which analyze job exhaustion and burnout [14,15,16,17]. Teacher burnout is also the focus of an increasing number of studies [18,19,20,21]. Additionally, working parents may experience high levels of stress in the home environment during the COVID-19 pandemic, leading to parental burnout [22,23].
越来越多的经验证据表明，由于 COVID-19 大流行，职业健康现在比以往任何时候都更加重要。特别是，疫情给医护人员带来了相当大的心理压力。自 COVID-19 爆发以来，针对世界各地一线医护人员、医生、护士或药剂师的样本开展了大量与职业倦怠相关的研究 [9,10,11,12]。然而，由于缺乏大流行前的倦怠基线水平，因此很难比较同一人群的患病率变化。对过去疫情（例如 SARS、流感或埃博拉疫情）影响的研究证据表明，对认知和心理健康有长期影响（例如情绪困扰、创伤后应激障碍）[13]。该证据可用于为医护人员设计干预措施。对于广大工人来说，这也是一段艰难的时期。由于 COVID-19，全职远程办公受到了一些实证研究的关注，这些研究分析了工作疲惫和职业倦怠 [14,15,16,17]。教师倦怠也是越来越多研究的焦点[18,19,20,21]。此外，在 COVID-19 大流行期间，在职父母可能会在家庭环境中承受很大的压力，导致父母倦怠 [22, 23]。

This review aims to understand what burnout is and its different components, how it occurs, to identify the factors that trigger burnout and the individual factors that modulate it, to identify the effects that burnout generates at both individual and organizational levels, to understand which are the main actions that can be used to prevent and/or reduce burnout, and to present the main tools that currently exist to measure burnout.
本综述旨在了解什么是倦怠及其不同的组成部分、它是如何发生的、确定引发倦怠的因素以及调节倦怠的个人因素、确定倦怠在个人和组织层面产生的影响、了解哪些是倦怠的影响因素。可用于预防和/或减少倦怠的主要行动，并介绍目前衡量倦怠的主要工具。

2. Burnout: Definition and Development of This Construct
2.倦怠：这一结构的定义和发展

Overall, burnout syndrome is an individual response to chronic work stress that develops progressively and can eventually become chronic, causing health alterations [24]. From a psychological point of view, this syndrome causes damage at a cognitive, emotional, and attitudinal level, which translates into negative behavior towards work, peers, users, and the professional role itself [25]. However, it is not a personal problem, but a consequence of certain characteristics of the work activity [26].
总体而言，倦怠综合症是个人对慢性工作压力的一种反应，这种反应逐渐发展，最终可能变成慢性，导致健康改变[24]。从心理学的角度来看，这种综合症会在认知、情感和态度层面造成损害，从而转化为对工作、同事、用户和专业角色本身的负面行为[25]。然而，这不是个人问题，而​​是工作活动某些特征的结果[26]。

Historically, Graham Greene was the first author to use the term burnout in his novel “A Burnt-Out Case” when describing the story of an architect who found neither meaning in his profession nor pleasure in life. Later, the term was picked up and introduced in the psychological sphere by Freudenberger [27], where he described burnout as a state of exhaustion, fatigue, and frustration due to a professional activity that fails to produce the expected expectations. Initially, this author delimited it as something exclusively related to volunteer workers in a care center where all kinds of people with mental disorders and social problems attended. Because of their occupation, these workers experienced in crescendo a loss of energy to the point of exhaustion and demotivation, as well as aggressiveness towards the service users.
历史上，格雷厄姆·格林是第一个在他的小说《倦怠案例》中使用“倦怠”一词的作者，当时他描述了一位建筑师的故事，他在职业中找不到意义，在生活中也找不到乐趣。后来，这个术语被 Freudenberger 采纳并引入心理学领域 [27]，他将倦怠描述为由于专业活动未能产生预期期望而导致的一种疲惫、疲劳和沮丧的状态。最初，笔者将其界定为专门与护理中心的志愿者相关的事物，该护理中心聚集了各种患有精神障碍和社会问题的人。由于他们的职业，这些工人会逐渐失去精力，甚至精疲力尽、缺乏动力，并对服务使用者产生攻击性。

Shortly thereafter, Maslach [28] introduced burnout into the scientific literature and defined it as a gradual process of fatigue, cynicism, and reduced commitment among social care professionals. Years later and after several empirical studies, Maslach and Jackson [5] reformulated the concept and elaborated a more rigorous and operational definition of burnout as a psychological syndrome characterized by emotional exhaustion, depersonalization and a reduced sense of professional efficacy that can appear in caregivers (Table 1). The turning point between the two definitions is the consideration of burnout as a syndrome, with a syndrome being understood as a picture or set of symptoms and signs that exist at the same time and clinically define a particular state distinct from others.
此后不久，Maslach [28] 将倦怠引入科学文献中，并将其定义为社会护理专业人员逐渐疲劳、愤世嫉俗和承诺减少的过程。多年后，经过多次实证研究，Maslach 和 Jackson [5] 重新阐述了这一概念，并详细阐述了职业倦怠的更严格和可操作的定义，它是一种心理综合症，其特征是情绪耗竭、人格解体和职业效能感降低，可能出现在护理人员身上。表格1）。这两个定义之间的转折点是将倦怠视为一种综合症，综合症被理解为同时存在的一组图片或一组症状和体征，并在临床上定义与其他状态不同的特定状态。

Table 1. Burnout dimensions.

Dimension	Definition
Emotional exhaustion	This dimension manifests in the form of feelings and sensation of being exhausted by the psychological efforts made at work. It is also described in terms of weariness, tiredness, fatigue, weakening, and the subjects who manifest this type of feelings show difficulties in adapting to the work environment since they lack sufficient emotional energy to cope with work tasks.
Cynicism or depersonalization	This dimension, the interpersonal component of burnout, is defined as a response of detachment, indifference and unconcern towards the work being performed and/or the people who receive it. It translates into negative or inappropriate attitudes and behaviors, irritability, loss of idealism, and interpersonal avoidance usually towards service users, patients, and/or clients.
Reduced personal achievement	This dimension is reflected in a negative professional self-evaluation and doubts about the ability to perform the job effectively, as well as a greater tendency to evaluate results negatively. It also translates into a decrease in productivity and capabilities, low morale, as well as lower coping skills.

However, some authors have argued that these three dimensions are not completely independent. Thus, it is possible to find several explanations in the literature. The difference between them lies in which is the first dimension that appears in the face of job stress (emotional exhaustion or depersonalization). Although definitive evidence has not yet been obtained, longitudinal studies have shown that there is a causal order between the key dimensions of burnout. Thus, high levels of emotional exhaustion lead to high levels of cynicism or depersonalization [29]. Likewise, empirical studies indicate that exhaustion and depersonalization constitute the core or key dimensions of the syndrome of being burned out at work, while lack of professional fulfillment is considered as an antecedent of burnout or even a consequence [30].
然而，一些作者认为这三个维度并不是完全独立的。因此，可以在文献中找到几种解释。它们之间的区别在于，面对工作压力时首先出现的维度是哪一个（情绪疲惫或人格解体）。尽管尚未获得明确的证据，但纵向研究表明，倦怠的关键维度之间存在因果关系。因此，高度的情绪耗竭会导致高度的愤世嫉俗或人格解体[29]。同样，实证研究表明，疲惫和人格解体构成了工作倦怠综合症的核心或关键维度，而缺乏职业成就感被认为是倦怠的前因，甚至是后果[30]。

Finally, although Maslach and Jackson’s [5] conceptualization of burnout remains the most widely accepted, other definitions or formulations are found in the scientific literature. For example, Salanova et al. [31] reformulate such approaches and propose an extended model of burnout composed of: (1) exhaustion (related to crises in the relationship between the person and work in general), (2) mental distance that includes both cynicism (distant attitudes towards work in general) and depersonalization (distant attitudes towards the people for and with whom one works) and (3) professional inefficacy (feeling of not doing tasks adequately and being incompetent at work).
最后，尽管 Maslach 和 Jackson [5] 对倦怠的概念化仍然是最广泛接受的，但在科学文献中也可以找到其他定义或表述。例如，萨拉诺瓦等人。 [31]重新阐述了这些方法，并提出了一种扩展的倦怠模型，其中包括：（1）疲惫（与人与工作之间关系的危机有关），（2）心理距离，包括愤世嫉俗（对工作的疏远态度）总体而言）和人格解体（对自己工作的人以及与他一起工作的人持疏远态度）以及（3）专业效率低下（感觉没有充分完成任务并且在工作中无能）。

2.1. Subtypes of Burnout 2.1.倦怠的亚型

As an alternative to the unitary definition of burnout, Montero-Marín [24] proposes that this syndrome does not always develop in the same way and that, on the contrary, there can be three variations that depend on the dedication of workers to their work activity (Figure 1). These subtypes could also be understood as stages in which there is a progressive deterioration in the levels of worker commitment to their job and have repercussions when choosing the intervention to be applied [32]. From this theoretical perspective, burnout is considered a developing condition, with a progressive reduction in levels of engagement, and evolves from enthusiasm to apathy [24]. Burnout is proposed to typically appear with the excessive involvement characteristic of the frenetic subtype. Since it is not easy to maintain this level of activity without becoming exhausted, the worker may adopt a certain protective distance. This distancing may relieve workers from overactivity, but at the cost of the frustration that emerges in the under-challenged subtype. In the long run, this leads to a reduced perception of efficacy, giving way to passive coping strategies, typically present in the worn-out subtype. The parallelism between the evolution of the syndrome and the different subtypes raises the possibility of implementing new lines of therapeutic intervention on burnout by understanding the subtypes as a succession of stages in the development of the syndrome [24]. Indeed, empirical studies suggest a progressive deterioration from the frenetic to the under-challenged and worn-out [33]. Nevertheless, more longitudinal studies are still needed to clarify the transition from one subtype to another and the evolution of the syndrome.
作为倦怠统一定义的替代方案，Montero-Marín [24] 提出，这种综合症并不总是以相同的方式发展，相反，可能存在三种变化，具体取决于工人对工作的奉献程度活动（图1）。这些亚型也可以理解为工人对工作的投入程度逐渐恶化的阶段，并在选择要应用的干预措施时产生影响[32]。从这个理论角度来看，倦怠被认为是一种发展状况，参与程度逐渐降低，并从热情演变为冷漠[24]。倦怠被认为通常伴随着狂热亚型的过度参与特征而出现。由于保持这种活动水平而不感到疲惫并不容易，因此工人可以采取一定的防护距离。这种距离可能会缓解员工过度活跃的情况，但代价是缺乏挑战的亚型会出现挫败感。从长远来看，这会导致人们对功效的感知降低，让位于被动应对策略，通常出现在疲惫的亚型中。该综合征与不同亚型的演变之间的平行性提出了通过将亚型理解为该综合征发展的一系列阶段来对倦怠实施新的治疗干预措施的可能性[24]。事实上，实证研究表明，从狂热到缺乏挑战和疲惫不堪，情况逐渐恶化[33]。尽管如此，仍需要更多的纵向研究来阐明从一种亚型到另一种亚型的转变以及该综合征的演变。

Figure 1. Profiles and subtypes of burnout.
图 1. 职业倦怠的概况和亚型。

The frenetic subtype is typical of work contexts with overload and workers who work intensely until exhaustion. It also tends to be more frequent in jobs with split shifts, temporary contracts and, in general, situations that force workers to be much more involved to keep the job. It is the subtype of burnout in which workers show greater dedication to work. At the motivational level, these workers show high involvement and need to obtain important achievements and it has been related to a coping style based on the attempt to solve problems actively, for which they use a high number of working hours per week or are involved in different jobs at the same time. For all these reasons, this profile is associated with high levels of burnout and a feeling of abandonment of personal life and health at work.
疯狂亚型是典型的超负荷工作环境和紧张工作直至精疲力尽的工人。在轮班、临时合同以及一般情况下迫使工人更多地参与以保住工作的情况下，这种情况也往往更为频繁。这是职业倦怠的一种亚型，员工对工作表现出更大的奉献精神。在激励层面上，这些员工表现出较高的投入度，需要取得重要的成就，这与他们每周花费大量工作时间或参与积极解决问题的应对方式有关。同时从事不同的工作。由于所有这些原因，这种情况与高度倦怠以及放弃个人生活和工作健康的感觉有关。

The under-challenged subtype is typical of monotonous and unstimulating professions, with repetitive, mechanical, and routine tasks that do not provide the necessary satisfaction to workers, who state that the work is not rewarding and is monotonous. Consequently, workers show indifference, boredom, and lack of personal development along with a desire to change jobs. This subtype of burnout is related to high levels of cynicism, due to a lack of identification with work tasks, and is associated with an escapist coping style, based on distraction or cognitive avoidance.
挑战不足的亚型是典型的单调、无刺激的职业，从事重复性、机械性和例行公事的任务，不能为工人提供必要的满足感，他们认为工作没有回报而且单调。因此，工人表现出冷漠、无聊、缺乏个人发展以及换工作的愿望。这种倦怠亚型与高度愤世嫉俗有关，因为缺乏对工作任务的认同，并且与基于分心或认知回避的逃避现实的应对方式有关。

The worn-out subtype is characterized mainly by feelings of hopelessness and a sense of lack of control over the results of their work and recognition of the efforts invested, so that they finally opt for neglect and abandonment as a response to any difficulty. It is, therefore, the profile in which the worker shows less dedication. Thus, this type of profile is strongly associated with the perception of inefficiency and a passive style of coping with stress, based mainly on behavioral disconnection, which generates a strong sense of incompetence and makes them experience feelings of guilt.
疲惫亚型的主要特征是感到绝望、对工作结果缺乏控制感、对所付出的努力缺乏认可，因此他们最终选择忽视和放弃来应对任何困难。因此，在这种情况下，工人表现出较少的奉献精神。因此，这种类型的形象与低效率的感知和主要基于行为脱节的被动应对压力的方式密切相关，这会产生强烈的无能感，并使他们体验到内疚感。

2.2. Why Does Burnout Appear and How Does It Develop?
2.2.为什么会出现职业倦怠以及它是如何发展的？

Since the appearance of the term in the scientific literature, several approaches have emerged that have attempted to answer the question of why burnout appears and how it develops. In this section, we will focus on detailing the most current and empirically supported explanatory theories of burnout considering that, instead of being antagonistic to each other, they are complementary and provide a more global view of this syndrome. Specifically, the following theories are summarized: (1) social cognitive theory; (2) social exchange theory; (3) organizational theory; (4) structural theory; (5) job demands–resources theory; (6) emotional contagion theory.
自从这个术语出现在科学文献中以来，已经出现了几种方法试图回答倦怠为何出现以及它是如何发展的问题。在本节中，我们将重点详细介绍最新的、有经验支持的倦怠解释理论，考虑到它们不是相互对立的，而是互补的，并提供了对这种综合症的更全面的看法。具体来说，可归纳为以下理论：（1）社会认知理论； (2)社会交换理论； (3)组织理论； (4)结构理论； (5)工作需求-资源理论； (6)情绪传染理论。

2.2.1. Social Cognitive Theory
2.2.1.社会认知理论

This approach is characterized by giving a central role to individual variables such as self-efficacy, self-confidence and self-concept in the development and evolution of burnout [34,35]. So, this syndrome is triggered when the worker harbors doubts about their own effectiveness, or that of their group, in achieving professional goals [36,37]. These approaches were corroborated in a study conducted in a Spanish context with 274 secondary school teachers showing that burnout occurred after the emergence of professional efficacy crises [36].
这种方法的特点是在倦怠的发展和演变中赋予自我效能、自信和自我概念等个体变量核心作用[34, 35]。因此，当员工对自己或团队在实现职业目标方面的有效性产生怀疑时，就会引发这种综合症[36, 37]。这些方法在西班牙背景下对 274 名中学教师进行的一项研究中得到了证实，该研究表明职业效能危机出现后会出现职业倦怠 [36]。

The circumstances facilitate the development of inefficacy expectations or efficacy crises are the following [38]: (1) negative experiences of failure in the past, (2) lack of reference models who have gone through a similar experience and have overcome it, (3) lack of external reinforcement for the work, (4) lack of feedback on the work completed or excessive negative criticism, and (5) difficulties at work. In this way, crises of effectiveness would lead to low professional fulfillment which, if maintained over time, would generate emotional exhaustion and then cynicism/depersonalization as a way of coping with stress (Figure 2).
促成无效期望或功效危机发展的情况如下[38]：（1）过去失败的负面经历，（2）缺乏经历过类似经历并克服它的参考模型，（3） ) 工作缺乏外部强化； (4) 完成的工作缺乏反馈或过多的负面批评； (5) 工作中的困难。这样，效率危机将导致职业成就感低下，如果长期维持下去，就会产生情绪疲惫，然后产生愤世嫉俗/人格解体，以此作为应对压力的一种方式（图2）。

Figure 2. Development of burnout according to the socio-cognitive theory of the self-efficacy.
图 2. 根据自我效能的社会认知理论，倦怠的发展。

2.2.2. Social Exchange Theory
2.2.2.社会交换理论

This theory considers that burnout occurs when the worker perceives a lack of equity between the efforts and contributions made and the results obtained in their work [39]. This lack of reciprocity, which can occur with service users, colleagues, supervisors, and organizations, consumes the emotional resources of professionals, generating an emotional exhaustion that becomes chronic. From this approach, burnout can be triggered by the significant interpersonal demands involved in dealing with clients/users that become emotionally consuming. Thus, to avoid contact with the original source of discomfort, depersonalization or cynicism is used as a stress coping strategy, which ultimately leads to low personal fulfillment (Figure 3).
该理论认为，当工人意识到所做的努力和贡献与工作中获得的结果之间缺乏公平时，就会发生倦怠[39]。这种缺乏互惠的情况可能发生在服务使用者、同事、主管和组织之间，消耗了专业人员的情感资源，产生了长期的情感疲惫。通过这种方法，在与情绪消耗的客户/用户打交道时涉及的重要人际需求可能会引发倦怠。因此，为了避免接触最初的不适来源，人们会使用去个性化或愤世嫉俗作为压力应对策略，这最终会导致个人成就感降低（图3）。

Figure 3. Development of burnout according to social exchange theory.
图 3. 根据社会交换理论，职业倦怠的发展。

2.2.3. Organizational Theory
2.2.3.组织理论

This approach considers that burnout is a consequence of organizational and work stressors (see Section 3.1) combined with inadequate individual coping strategies [40,41]. Within this theory, there are two alternative models to explain the relationships between the dimensions of burnout. According to Golembiewski et al. [41], burnout starts because of the existence of organizational stressors or risk factors, such as work overload or role ambiguity, and before which some individuals show as a coping strategy a decrease in their organizational commitment, which is very similar to cynicism and depersonalization. Subsequently, the person will experience low personal fulfillment at work and emotional exhaustion, which triggers burnout syndrome. Thus, depersonalization would be the first phase of burnout, followed by a feeling of low self-fulfillment and, finally, emotional exhaustion. The alternative proposal is that put forward by Cox et al. [40]. For these authors, the emotional exhaustion caused by enduring work stressors is the initial dimension of this syndrome. Depersonalization is considered a coping strategy in the face of emotional exhaustion and low personal fulfillment is the result.
这种方法认为，倦怠是组织和工作压力源（参见第 3.1 节）与个人应对策略不足相结合的结果 [40, 41]。在这个理论中，有两种替代模型来解释倦怠维度之间的关系。根据 Golembiewski 等人的说法。 [41]，职业倦怠是由于组织压力源或风险因素的存在而开始的，例如工作超负荷或角色模糊，在此之前，一些个体表现出减少组织承诺作为应对策略，这与犬儒主义和人格解体非常相似。随后，该人会在工作中经历低个人成就感和情绪疲惫，从而引发倦怠综合症。因此，人格解体将是倦怠的第一阶段，随后是自我实现感低下，最后是情绪疲惫。另一种建议是 Cox 等人提出的。 [40]。对于这些作者来说，持久的工作压力造成的情绪疲惫是这种综合症的最初维度。去个性化被认为是面对情绪疲惫时的一种应对策略，结果是个人成就感低下。

2.2.4. Demands–Resources Theory
2.2.4.需求-资源理论

This approach postulates that burnout occurs when there is an imbalance between the demands and resources derived from work [42]. Job demands are those job factors that require sustained physical or mental effort and are associated with certain physiological costs due to activation of the hypothalamic–pituitary–adrenal axis and psychological costs (e.g., subjective fatigue, reduced focus of attention, and redefinition of task requirements). Common work demands include work overload, emotional labor, time pressure, or interpersonal conflicts. When recovery in the face of such demands is insufficient or inadequate, a state of physical and mental exhaustion is triggered.
这种方法假设，当工作带来的需求和资源之间不平衡时，就会发生倦怠[42]。工作需求是那些需​​要持续体力或脑力努力的工作因素，并且由于下丘脑-垂体-肾上腺轴的激活而与某些生理成本和心理成本相关（例如主观疲劳、注意力集中度降低和任务要求的重新定义） ）。常见的工作需求包括超负荷工作、情绪劳动、时间压力或人际冲突。当面对这些需求时恢复不充分或不充分，就会引发身心疲惫的状态。

Work resources, on the other hand, refer to the physical, psychological, organizational, or social aspects of work that can reduce the demands of work and the associated physiological and psychological costs and that can be decisive in achieving work objectives. Resources at work can be organizational in nature, but also personal (Table 2). When demands exceed resources, fatigue occurs; if this imbalance is maintained over time, fatigue becomes chronic and, finally, burnout appears. Therefore, job demands have a direct and positive relationship with burnout, especially emotional exhaustion, while the existence of job resources inversely influences depersonalization by minimizing or reducing its use as a coping strategy.
另一方面，工作资源是指工作的身体、心理、组织或社会方面，这些方面可以减少工作要求以及相关的生理和心理成本，并且对实现工作目标具有决定性作用。工作中的资源可以是组织性的，也可以是个人性的（表 2）。当需求超过资源时，就会出现疲劳；如果这种不平衡持续下去，疲劳就会变成慢性，最后就会出现倦怠。因此，工作要求与倦怠，特别是情绪耗竭有直接和积极的关系，而工作资源的存在通过最小化或减少其作为应对策略的使用来反向影响去个性化。

Table 2. Summary of main demands and job resources.

Job Demands	Job Resources
Temporary pressure Interpersonal conflicts with clients and colleagues Task complexity Job insecurity Unfavorable schedule changes Qualitative and quantitative work overload Personal occupational hazards	Individual Technical knowledge and skills Socio-emotional skills Positive psychological capital (self-efficacy, optimism, hope and resilience) Creativity Organizational Time flexibility Job security Supervisor and peer support Material resources Autonomy Rewards

2.2.5. Structural Theory 2.2.5。结构理论

This approach maintains that burnout is a response to chronic job stress that appears when the coping strategies employed by the individual to manage job stressors fail. Initially, work stress will elicit a series of coping strategies. When the coping strategies initially employed are not successful, they lead to professional failure and to the development of feelings of low personal fulfillment at work and emotional exhaustion. Faced with these feelings, the subject develops depersonalization attitudes as a new form of coping. (The sequence is illustrated in Figure 4.) In turn, burnout will have adverse consequences both for the health of individuals and for organizations. This model has been empirically contrasted with different professional groups such as teachers or nurses [43].
这种方法认为，倦怠是对长期工作压力的反应，当个人用于管理工作压力源的应对策略失败时，就会出现这种情况。最初，工作压力会引发一系列应对策略。当最初采用的应对策略不成功时，就会导致职业失败，并导致个人工作成就感低下和情绪疲惫。面对这些感受，主体会发展出人格解体态度作为一种新的应对方式。 （该顺序如图 4 所示。）反过来，倦怠会对个人和组织的健康产生不利影响。该模型已与教师或护士等不同专业群体进行了实证对比[43]。

Figure 4. Development of burnout according to structural theory.
图 4.根据结构理论的倦怠发展。

2.2.6. Theory of Emotional Contagion
2.2.6。情绪传染理论

Emotional contagion refers to the tendency to automatically imitate and synchronize facial expressions, vocalizations, postures, and movements with those of other people and, consequently, to converge emotionally with them [44]. When people work together, it is common for them to share situations and experience collective emotions, such as sadness, fear, or exhaustion. Therefore, from this theory it is considered that burnout occurs in work groups, since there are shared beliefs and emotions that are developed throughout social interaction [38]. This burnout contagion has been evidenced especially in teaching and health personnel [45], as well as between spouses (outside work). Thus, emotional contagion influences the development of burnout both inside and outside the workplace [26,46].
情绪传染是指自动模仿他人的面部表情、声音、姿势和动作并使其同步的倾向，从而在情感上与他人趋同[44]。当人们一起工作时，他们通常会分享情况并体验集体情绪，例如悲伤、恐惧或疲惫。因此，根据这一理论，人们认为倦怠发生在工作群体中，因为在社会互动过程中形成了共同的信念和情感[38]。这种倦怠蔓延的现象在教学和卫生人员中尤其明显[45]，以及配偶之间（工作之外）。因此，情绪传染会影响工作场所内外倦怠的发展[26, 46]。

3. What Circumstances Trigger Burnout?
3.什么情况会引发倦怠？

The antecedents are those aspects that are going to propitiate, trigger, and/or maintain people suffering from burnout syndrome. In general, these aspects can be classified into two broad categories: (1) organizational factors such as, for example, the workload or the emotional demands involved, and (2) individual factors such as, for example, the worker’s personality or coping strategies. It is important to emphasize that this syndrome is primarily a consequence of exposure to certain working conditions and not an individual characteristic such as a personality trait. Strictly speaking, therefore, the triggers of burnout would be factors related to the work (be it content, structure or relationships with users, clients, bosses, and/or colleagues). However, it is considered that, although organizational factors are capable per se of generating burnout, certain individual factors would act as moderating variables. Thus, personal aspects such as, for example, a lack of self-confidence or the use of stress-avoidance coping mechanisms could play a role in enhancing situational factors. On the other hand, other individual characteristics, such as optimism or active coping, can lessen or even slow down the negative effect of organizational factors on burnout and its consequences.
前因是那些将安抚、触发和/或维持人们遭受倦怠综合症的方面。一般来说，这些方面可以分为两大类：（1）组织因素，例如工作量或所涉及的情感需求，以及（2）个人因素，例如工人的个性或应对策略。需要强调的是，这种综合症主要是暴露于某些工作条件的结果，而不是诸如人格特质等个人特征。因此，严格来说，倦怠的触发因素是与工作相关的因素（无论是内容、结构还是与用户、客户、老板和/或同事的关系）。然而，人们认为，虽然组织因素本身能够产生倦怠，但某些个人因素可以充当调节变量。因此，个人方面，例如缺乏自信或使用压力避免应对机制，可能会在增强情境因素方面发挥作用。另一方面，其他个人特征，例如乐观或积极应对，可以减轻甚至减缓组织因素对倦怠及其后果的负面影响。

3.1. Organizational Factors
3.1.组织因素

Regarding situational factors, reviews of the scientific literature [47] show that, in general, both the type of tasks, the way they are organized and the relationships between colleagues, bosses, and/or clients are potential burnout triggers or risk factors.
关于情境因素，对科学文献的回顾[47]表明，一般来说，任务的类型、任务的组织方式以及同事、老板和/或客户之间的关系都是潜在的倦怠触发因素或风险因素。

3.1.1. Work Overload 3.1.1.工作超负荷

Workload, both quantitative and qualitative, when excessive, requires sustained effort, generating physiological and psychological costs. Such symptoms can trigger the experience of burnout and psychological distancing from work as a self-defense mechanism [48].
定量和定性的工作量如果过多，则需要持续的努力，从而产生生理和心理成本。作为一种自卫机制，这些症状可能会引发倦怠感和远离工作的心理[48]。

3.1.2. Emotional Labor 3.1.2.情绪劳动

Emotional labor is understood as the psychological process necessary to self-regulate one’s emotions and show those emotions desired by the organization. It involves controlling or hiding negative emotions such as anger, irritation or discomfort to comply with the rules or requirements of the organization and objectives of the job, as well as the display of emotions not felt, such as sympathy towards customers or users, although the opposite is really felt, or tranquility in situations in which what is really felt is fear. Emotional labor will therefore involve a greater workload. In this sense, several studies have shown positive relationships between emotional labor and burnout in different professions, such as teachers [49] and HR department workers [50].
情绪劳动被理解为自我调节情绪并表现出组织所期望的情绪所必需的心理过程。它涉及控制或隐藏负面情绪，例如愤怒、恼怒或不适，以遵守组织的规则或要求和工作目标，以及表现出未感受到的情绪，例如对客户或用户的同情，尽管真正感受到的是相反的东西，或者在真正感受到的是恐惧的情况下的平静。因此，情绪劳动会涉及更大的工作量。从这个意义上说，一些研究表明不同职业的情绪劳动和倦怠之间存在正相关关系，例如教师[49]和人力资源部门工作人员[50]。

3.1.3. Lack of Autonomy and Influence at Work
3.1.3.工作中缺乏自主权和影响力

Lack of freedom at work when performing tasks, as well as the inability to influence decisions that affect work has been positively associated with higher levels of burnout. Conversely, when workers experience autonomy and control over their work, there are lower rates of burnout and higher rates of professional fulfillment [48]. In this line, several investigations have found negative relationships between burnout and empowerment, so that the greater the empowerment perceived by workers, the lower the levels of burnout experienced [51,52].
执行任务时缺乏工作自由，以及无法影响影响工作的决策，与较高程度的倦怠呈正相关。相反，当员工对工作拥有自主权和控制权时，倦怠率就会降低，职业成就感就会提高[48]。在这方面，多项调查发现倦怠与赋权之间存在负相关关系，因此员工感知到的赋权越大，倦怠程度就越低[51, 52]。

3.1.4. Ambiguity and Role Conflict
3.1.4.模糊性和角色冲突

When the worker does not know what is expected of them and/or does not have enough information about their mission (role ambiguity) or in their case the different tasks and demands to be fulfilled are incongruent or incompatible with each other (role conflict), burnout levels are increased [53].
当员工不知道对他们的期望和/或没有足够的关于他们的使命的信息（角色模糊）或在他们的情况下，不同的任务和要完成的要求彼此不一致或不兼容（角色冲突）时，倦怠程度增加[53]。

3.1.5. Inadequate Supervision and Perception of Injustice
3.1.5。监督不足和不公正现象

The perception of inadequate supervision (e.g., excessively directive, and unfair by only focusing on the negative aspects without valuing achievements and efforts, or at the other extreme not at all directive or non-existent) increases the risk of developing burnout. On the contrary, a fair treatment with employees favors the increase in available resources, exerting a negative effect on emotional exhaustion in such a way that workers are less likely to develop burnout symptomatology [54].
认为监督不充分（例如，过度指导和不公平，只关注负面方面而不重视成就和努力，或者在另一个极端，根本没有指导或不存在）会增加产生倦怠的风险。相反，公平对待员工有利于增加可用资源，对情绪疲惫产生负面影响，从而降低员工出现倦怠症状的可能性[54]。

3.1.6. Lack of Perceived Social Support
3.1.6。缺乏感知的社会支持

Lack of social support at work, either from co-workers or supervisors, as well as internal conflicts between co-workers are considered important triggers of burnout. On the contrary, social support has been found to act as a brake on this syndrome [55].
工作中缺乏来自同事或主管的社会支持，以及同事之间的内部冲突被认为是职业倦怠的重要触发因素。相反，社会支持被发现可以抑制这种综合症[55]。

3.1.7. Poor Working Hours
3.1.7.工作时间差

The working hours conditions that make it difficult to reconcile family and professional life are another important trigger of burnout. For instance, shift work, high rotations, night work, long working hours, or a large amount of overtime are powerful triggers of burnout. Additionally, such hourly characteristics are positively related to sleep disorders, heart problems, health complaints, job dissatisfaction, decreased attention and performance, as well as an increased risk of accidents [48].
难以协调家庭和职业生活的工作时间条件是职业倦怠的另一个重要触发因素。例如，轮班工作、高轮换、夜间工作、长时间工作或大量加班都是职业倦怠的强大诱因。此外，这种每小时的特征与睡眠障碍、心脏问题、健康问题、工作不满、注意力和表现下降以及事故风险增加呈正相关[48]。

3.2. Individual Factors Modulating Burnout
3.2.调节倦怠的个体因素

Regarding individual factors, both personality traits and sociodemographic variables and coping strategies have been analyzed as predisposing or facilitating the development of burnout in the case of the presence of some of the organizational factors explained above. Table 3 summarizes these factors and their modulating effect on burnout: positive (they amplify the effect of social factors) or negative (they reduce the effect of social factors).
关于个人因素，人格特质、社会人口变量和应对策略都被分析为在存在上述一些组织因素的情况下诱发或促进倦怠的发展。表 3 总结了这些因素及其对倦怠的调节作用：积极的（它们放大了社会因素的影响）或消极的（它们减少了社会因素的影响）。

Table 3. Individual burnout modulators.

Protectors of Burnout	Enhancers of Burnout
Agreeableness Conscientiousness Extraversion Openness to experience Positive psychological capital Problem-focused coping	Neuroticism External locus of control Type A Personality Alexithymia Emotion-focused coping

Personality influences how people perceive their work environment and, therefore, how they manage and cope with work demands and resources. Several studies [56,57,58] conclude that the personality traits posited in the Big Five model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience; [59]) are significantly but differentially associated with burnout. Thus, it has been found that there is a negative correlation between extraversion and the components of burnout. Thus, extraversion will be a protective factor against burnout. As for neuroticism or emotional instability, positive correlations have been found with burnout. Therefore, people with less emotional stability will be more likely to suffer from burnout. Agreeableness is another personality factor that has shown a protective effect on burnout, so that more-agreeable workers tend to experience less burnout than their less-agreeable colleagues. Likewise, conscientiousness, or the tendency to behave responsibly and persistently, reduces the likelihood of burnout. Finally, openness to experience that represents aspects related to breadth of interests and creativity also has protective effects on burnout as it is positively associated with professional efficacy and negatively associated with depersonalization.
个性影响人们如何看待他们的工作环境，从而影响他们如何管理和应对工作需求和资源。多项研究 [56,57,58] 得出结论，大五模型中提出的人格特质（外向性、神经质、宜人性、尽责性和对经验的开放性；[59]）与倦怠显着但有差异相关。因此，人们发现外向性与倦怠的组成部分之间存在负相关关系。因此，外向性将成为防止倦怠的保护因素。至于神经质或情绪不稳定，已发现与倦怠呈正相关。因此，情绪稳定性较差的人更容易出现职业倦怠。宜人性是另一个对倦怠具有保护作用的人格因素，因此宜人的员工往往比不太宜人的同事经历更少的倦怠。同样，尽责性，或者负责任且坚持不懈地行事的倾向，可以降低倦怠的可能性。最后，对代表与兴趣广度和创造力相关的经验的开放态度也对职业倦怠具有保护作用，因为它与职业效能呈正相关，与人格解体呈负相关。

Other individual characteristics that influence the development of burnout are the external locus of control, the type A behavior pattern and having high expectations. Locus of control [60] refers to the degree to which people believe they have control over events and their lives (internal locus of control) and the degree to which they believe that events occur due to external causes such as chance or the decisions of others (external locus of control). The greater the external locus of control, the greater the probability of developing burnout, especially in ambiguous or novel situations, in which the persons believe they have little or no possibility of controllability. Type A behavior pattern is characterized by competitiveness, impulsivity, impatience, and aggressiveness, and has been widely implicated as a health risk factor. This behavior pattern is positively related to the emotional exhaustion and depersonalization factors of burnout. Finally, the expectations that employees have regarding their work are related to the level of burnout, such that higher expectations and higher goal setting lead to greater efforts and thus higher levels of emotional exhaustion and depersonalization [47,48]. The person’s level of involvement also seems to be important. Specifically, over-involvement has also been proposed as a potent trigger, especially when it may be impossible to achieve goals. This mismatch between expectations and realities can lead to frustration and burnout in workers.
其他影响职业倦怠发展的个人特征包括外部控制源、A 型行为模式和高期望。控制点[60]是指人们相信自己对事件和生活有控制力的程度（内部控制点），以及他们相信事件的发生是由于外部原因（例如偶然性或他人的决定）而发生的程度。 （外部控制点）。外部控制点越大，产生倦怠的可能性就越大，尤其是在模棱两可或新奇的情况下，人们认为自己几乎没有或根本没有控制的可能性。 A型行为模式的特点是竞争、冲动、急躁和攻击性，并被广泛认为是一种健康风险因素。这种行为模式与倦怠的情绪耗竭和人格解体因素呈正相关。最后，员工对工作的期望与倦怠程度相关，更高的期望和更高的目标设定会导致更大的努力，从而导致更高程度的情绪耗竭和人格解体[47, 48]。这个人的参与程度似乎也很重要。具体来说，过度参与也被认为是一个有效的触发因素，尤其是在不可能实现目标的情况下。期望与现实之间的不匹配可能会导致员工感到沮丧和倦怠。

In terms of sociodemographic variables, reviews of studies [47,48] point to an inverse relationship between age and burnout, such that people will experience lower levels of burnout as their age increases. However, the results are not always so consistent. A systematic review of the determinants of burnout [61] found a significant relationship between increasing age and increased risk of depersonalization, although on the other hand there is also a greater sense of personal accomplishment. Regarding gender, most studies indicate that emotional exhaustion and low professional fulfillment tend to be more common among women while depersonalization is more frequent in men. In relation to marital status, workers who are single (especially men) seem to be more exposed to burnout compared to those who live with a partner. However, such findings seem to be more appropriate in men, as in the case of working women, it constitutes an additional risk factor since working women are usually responsible for household chores and, therefore, this may pose a difficulty in reconciling personal and professional life.
就社会人口统计学变量而言，研究综述[47, 48]指出年龄和倦怠之间存在反比关系，因此随着年龄的增长，人们的倦怠程度会降低。然而，结果并不总是那么一致。对倦怠决定因素的系统回顾[61]发现，年龄增长与人格解体风险增加之间存在显着关系，尽管另一方面也存在更大的个人成就感。关于性别，大多数研究表明，情绪疲惫和职业成就感低下在女性中更为常见，而人格解体在男性中更为常见。就婚姻状况而言，与与伴侣同住的工人相比，单身工人（尤其是男性）似乎更容易感到倦怠。然而，这样的研究结果似乎更适合男性，就像职业女性一样，它构成了一个额外的风险因素，因为职业女性通常负责家务，因此，这可能会给协调个人生活和职业生活带来困难。 。

Coping strategies are another variable that play an important role in the development of burnout [62,63]. Although there are several classifications of coping strategies, the most established one is the distinction between problem-focused coping and emotion-focused coping [64]. Problem-focused coping represents an attempt to act directly on the stressful situation, whereas emotion-focused coping focuses on modifying negative emotional responses to stressful events, avoiding intervening on them. Empirical evidence suggests that, in general, avoidance and emotion-focused coping are positively related to burnout, that is, they favor it, whereas active and problem-focused coping are negatively related to burnout, that is, they reduce it. However, not all emotion-focused coping strategies increase burnout, as social support-seeking, reappraisal, and religious support, in some cases, have protective effects on burnout [55]. On the other hand, it has also been proposed that the effectiveness of problem-focused coping may depend on the control that individuals can exert over potential stressors in the work environment. Specifically, the use of problem-focused active coping strategies when there is little possibility of controlling and/or changing environmental stressors may exacerbate the undesirable effects of work stress; in such situations it is more advisable to employ coping strategies to facilitate adaptation to the situation. Therefore, one cannot be blunt in concluding that emotion-focused coping strategies are always negative since problem-focused coping only seems adaptive in controllable situations, while avoidance-oriented coping is adaptive in situations that are difficult to control [65].
应对策略是在职业倦怠的发展中发挥重要作用的另一个变量[62, 63]。尽管应对策略有多种分类，但最确定的一种是以问题为中心的应对和以情绪为中心的应对之间的区别[64]。以问题为中心的应对方式代表着直接对压力情况采取行动的尝试，而以情绪为中心的应对方式则侧重于改变对压力事件的负面情绪反应，避免对其进行干预。经验证据表明，一般来说，回避和以情绪为中心的应对方式与倦怠呈正相关，也就是说，它们有利于倦怠，而积极和以问题为中心的应对方式与倦怠呈负相关，也就是说，它们会减少倦怠。然而，并非所有以情绪为中心的应对策略都会增加倦怠，因为寻求社会支持、重新评估和宗教支持在某些情况下对倦怠具有保护作用[55]。另一方面，也有人提出，以问题为中心的应对方式的有效性可能取决于个人对工作环境中潜在压力源的控制力。具体来说，当控制和/或改变环境压力源的可能性很小时，使用以问题为中心的积极应对策略可能会加剧工作压力的不良影响；在这种情况下，更明智的做法是采用应对策略来促进适应情况。因此，我们不能直截了当地得出这样的结论：以情绪为中心的应对策略总是消极的，因为以问题为中心的应对策略似乎只在可控的情况下才具有适应性，而以回避为导向的应对策略则在难以控制的情况下才具有适应性[65]。

3.3. Future Research 3.3.未来的研究

This section has focused on summarizing the main triggers of burnout. However, since burnout symptoms develop and evolve differently depending on individual characteristics (e.g., personality or coping strategies) and the work environment (e.g., job demands or leadership styles), it is necessary to continue advancing the knowledge of which are the personal factors that in combination with certain contextual triggers produce greater or lesser symptomatology. For example, when faced with the same stressor, do all personality types experience the same symptoms and consequences? Which personalities are more vulnerable to developing burnout when faced with specific triggers? Which are the most potentially harmful combinations of individual characteristics and contextual triggers? And which are the least? From a temporal perspective, it would also be necessary to carry out more longitudinal studies to study the evolution of symptomatology.
本节重点总结倦怠的主要触发因素。然而，由于倦怠症状的发展和演变取决于个人特征（例如性格或应对策略）和工作环境（例如工作要求或领导风格），因此有必要继续加深对哪些个人因素是倦怠症状的认识。与某些背景触发因素相结合会产生或多或少的症状。例如，当面对相同的压力源时，所有性格类型都会经历相同的症状和后果吗？当面对特定的触发因素时，哪些人更容易出现倦怠？哪些是个人特征和情境触发因素最有潜在危害的组合？哪些是最少的？从时间角度来看，还需要进行更多的纵向研究来研究症状学的演变。

Finally, and because of the increase in home working during the COVID-19 pandemic, it would also be interesting to examine whether teleworking may cause a greater or lesser occurrence of this symptomatology, compared to face-to-face work, as well as to examine possible differences depending on the sector of activity.
最后，由于 COVID-19 大流行期间在家工作的增加，与面对面工作相比，检查远程工作是否会导致这种症状的发生更多或更少，也很有趣。根据活动部门检查可能存在的差异。

4. Consequences of Burnout
4. 倦怠的后果

Burnout results in a series of adverse consequences both for the individuals who suffer from it and for the organizations in which these professionals work. These consequences are initially of a psychological nature, but maintained over time, they translate into adverse effects on the physical/biological health and behaviors of workers, which in turn will have undesirable organizational consequences [66].
职业倦怠会给遭受职业倦怠的个人和这些专业人员工作的组织带来一系列不利后果。这些后果最初是心理性质的，但随着时间的推移，它们会转化为对工人的身体/生物健康和行为的不利影响，进而产生不良的组织后果[66]。

4.1. Psychological Consequences
4.1.心理后果

The psychological alterations generated by the syndrome of being burned out at work occur at both cognitive and emotional levels. Different studies have associated this syndrome with concentration and memory problems, difficulty in making decisions, reduced coping capacity, anxiety, depression, dissatisfaction with life, low self-esteem, insomnia, irritability and increased alcohol and tobacco consumption [66,67]. Other researchers have also shown that this syndrome can pose a significant risk of suicide [68].
工作倦怠综合症所产生的心理变化发生在认知和情感层面。不同的研究表明，这种综合征与注意力和记忆力问题、决策困难、应对能力下降、焦虑、抑郁、对生活不满、自卑、失眠、易怒以及饮酒和吸烟增加有关[66, 67]。其他研究人员也表明，这种综合征可能会带来显着的自杀风险[68]。

4.2. Health Consequences 4.2.健康后果

Several reviews of studies conclude that employees with higher levels of burnout are more likely to suffer from a variety of physical health problems such as musculoskeletal pain, gastric alterations, cardiovascular disorders, headaches, increased vulnerability to infections, as well as insomnia and chronic fatigue [69]. Burnout has also been found to dangerously increase blood cortisol levels [70] and constitutes an independent risk factor for type 2 diabetes [71]. Now, the way these symptoms manifest themselves is not the same in all individuals, nor do they all have to occur.
多项研究综述得出的结论是，倦怠程度较高的员工更有可能遭受各种身体健康问题，如肌肉骨骼疼痛、胃部改变、心血管疾病、头痛、更容易感染、以及失眠和慢性疲劳。 69]。还发现倦怠会危险地增加血液皮质醇水平 [70]，并构成 2 型糖尿病的独立危险因素 [71]。现在，这些症状在每个人身上表现出来的方式并不相同，也不一定都会发生。

4.3. Behavioral Consequences
4.3.行为后果

In addition to physical and psychological health problems, in general, burnout is also directly related to job dissatisfaction [72], low organizational commitment [66], increased absenteeism [73], turnover intention [74], and reductions in performance [47]. On the other hand, some employees with burnout syndrome may justifiably leave their job; however, others decide to remain working [75]. This may lead to work presenteeism (i.e., individuals go to work, although they do not really fulfill their responsibilities due to health issues). In addition, burnout can lead to deviant and counterproductive behaviors in workers, aggressiveness among colleagues and towards users, alcohol and psychotropic drug use, misuse of corporate material, or even theft [68,69,75,76].
除了身心健康问题外，一般来说，倦怠还与工作不满[72]、组织承诺低[66]、缺勤增加[73]、离职倾向[74]和绩效下降[47]直接相关。 。另一方面，一些患有职业倦怠综合症的员工可能会合理地离职；然而，其他人决定继续工作[75]。这可能会导致工作出勤主义（即，尽管由于健康问题，个人并未真正履行其职责，但仍去上班）。此外，倦怠可能导致员工出现异常和适得其反的行为、同事之间和对用户的攻击性、酗酒和精神药物的使用、滥用公司材料，甚至盗窃[68,69,75,76]。

However, the form and evolution of these individual consequences (psychological, health, and behavioral) is not the same in all cases. In this sense, and although it is not always easy to delimit them, four levels of burnout syndrome have been described [77]:
然而，这些个体后果（心理、健康和行为）的形式和演变在所有情况下都不相同。从这个意义上说，尽管界定它们并不总是那么容易，但已经描述了倦怠综合症的四个级别[77]：

• Mild: those affected have mild, unspecific physical symptoms (headaches, back pain, low back pain), show some fatigue, and become less operative.
  轻度：受影响者有轻微的、非特异性的身体症状（头痛、背痛、腰痛），表现出一些疲劳，并且活动能力降低。
• Moderate: insomnia, attention and concentration deficits appear. At this level, detachment, irritability, cynicism, fatigue, boredom, progressive loss of motivation, making the individual emotionally exhausted with feelings of frustration, incompetence, guilt, and negative self-esteem.
  中度：出现失眠、注意力不集中。在这个水平上，冷漠、烦躁、愤世嫉俗、疲劳、无聊、逐渐丧失动力，使个人因沮丧、无能、内疚和消极自尊而情绪疲惫。
• Severe: increased absenteeism, task aversion and depersonalization, as well as alcohol and psychotropic drug abuse.
  严重：旷工、任务厌恶和人格解体增加，以及酗酒和精神药物滥用。
• Extreme: extreme behaviors of isolation, aggressiveness, existential crisis, chronic depression, and suicide attempts.
  极端：孤立、攻击性、存在危机、慢性抑郁和自杀企图等极端行为。

4.4. Organizational Consequences
4.4.组织后果

The negative consequences experienced at the individual level by workers with burnout translate into low motivation and performance that can extend to the work unit and the organization, causing a reduction in the quality of services [78]. Likewise, employees suffering from burnout influence the rest of the organization, causing greater conflicts or interrupting work tasks, thus reducing production and increasing production times [67]. Therefore, as indicated in the emotional contagion theory, burnout can cause a “contagion effect”, generating a bad working environment [45]. This syndrome also usually generates significant economic losses as a consequence of absenteeism, loss of efficiency and counterproductive behaviors [76].
职业倦怠的员工在个人层面所经历的负面后果会转化为低积极性和绩效，并可能延伸到工作单位和组织，导致服务质量下降[78]。同样，遭受倦怠的员工会影响组织的其他部分，导致更大的冲突或中断工作任务，从而减少产量并增加生产时间[67]。因此，正如情绪传染理论所指出的，倦怠会产生“传染效应”，产生不良的工作环境[45]。这种综合症通常还会因缺勤、效率损失和适得其反的行为而造成重大经济损失[76]。

4.5. Future Research 4.5.未来的研究

It would be interesting to examine in depth the relationships between the psychological alterations caused by burnout and the effects on workers’ health, safety, and performance. For example, how psychological damage caused by burnout influences workers’ attitudes and behavior, and exploration of the possible modulating role of individual factors and certain organizational characteristics (i.e., leadership, organizational climate, cohesion among workers). In addition, longitudinal studies would be necessary to analyze the possible relationship between the different consequences of burnout and productivity.
深入研究职业倦怠引起的心理变化与对工人健康、安全和绩效的影响之间的关系将会很有趣。例如，职业倦怠造成的心理伤害如何影响员工的态度和行为，以及探索个人因素和某些组织特征（即领导力、组织氛围、员工凝聚力）可能的调节作用。此外，有必要进行纵向研究来分析倦怠的不同后果与生产力之间可能的关系。

5. Prevention Strategies 5. 预防策略

Now we have established what burnout is and what circumstances trigger it, in this section we will focus on how to act both to avoid and to reverse its occurrence and consequences. First, the most appropriate type of preventive intervention should be selected. Primary prevention is aimed at all workers and its purpose is to reduce or eliminate organizational risk factors to prevent the occurrence of burnout. Primary prevention is the most consistent with the principles of an occupational risk prevention management system by providing workers with adequate support, job adaptations, information, and adequate training to deal with this psychosocial risk.
现在我们已经确定了什么是倦怠以及什么情况会引发它，在本节中我们将重点讨论如何采取行动来避免和扭转其发生和后果。首先，应选择最合适的预防干预类型。一级预防针对的是所有工人，其目的是减少或消除组织危险因素，防止职业倦怠的发生。一级预防最符合职业风险预防管理体系的原则，为工人提供足够的支持、工作适应、信息和足够的培训来应对这种心理社会风险。

Secondary prevention, on the other hand, is carried out once the first symptoms of burnout have appeared, so it is not aimed at all workers, but only at those who are already affected and its purpose in general is that such symptoms do not evolve further, improving the way in which the person responds to these stressors. These interventions are aimed more at individuals than at the organization, bringing about changes in attitudes and improving their coping resources, which does not imply that there are no organizational interventions as well. Finally, tertiary prevention focuses on employees who are already burned out at work. The aim of this type of prevention is to reduce the most severe harms (e.g., serious health problems and/or poor job performance). Since this type of intervention is aimed at trying to resolve the damage to the worker’s physical and/or psychological health, it is considered reactive and not strictly speaking prevention, but treatment.
另一方面，二级预防是在首次出现倦怠症状后进行的，因此它并不针对所有工人，而仅针对那些已经受到影响的工人，其总体目的是防止此类症状进一步发展，改善人们对这些压力源的反应方式。这些干预措施更多地针对个人而不是组织，带来态度的改变并改善他们的应对资源，但这并不意味着也没有组织干预。最后，三级预防的重点是那些已经在工作中精疲力尽的员工。此类预防的目的是减少最严重的伤害（例如，严重的健康问题和/或工作表现不佳）。由于这种类型的干预旨在试图解决对工人身体和/或心理健康的损害，因此它被认为是反应性的，严格来说不是预防，而是治疗。

From another perspective, we will classify the interventions considering the promoter of the intervention, that is, who organizes, decides and, if necessary, finances the actions to be carried out. In this sense, interventions can be classified as follows: (1) promoted by the organization, which in turn could be subdivided into actions directed at the organizational and job structure and actions directed at employees, and (2) promoted by individuals, which could also be subdivided into interventions directed at oneself as an individual and interventions directed at improving one’s interaction with the organization and with aspects of the job (Table 4).
从另一个角度来看，我们将考虑干预的推动者对干预进行分类，即谁组织、决定并在必要时资助要执行的行动。从这个意义上说，干预措施可以分为以下几类：（1）由组织推动，又可以细分为针对组织和工作结构的行动以及针对员工的行动；（2）由个人推动，这可以分为针对组织和工作结构的行动以及针对员工的行动。也可以细分为针对个人的干预措施和针对改善个人与组织和工作方面的互动的干预措施（表 4）。

Table 4. Summary of burnout interventions.

Promoted by the Organization		Promoted by the Worker
Aimed at the Structure	Aimed at Employees	Aimed at Oneself	Aimed at Aspects of the Job
Improvement of contents and workstations	Training	Physical exercise	Time management
Humanization of work schedules and implementation of work–life balance plans	Strengths-based interventions	Mindfulness training	Job crafting
Managers’ leadership development	Coaching and guidance	Self-assessment
Use of non-financial rewards and incentives	Creation of support groups	Psychotherapy
Development of welcome programs
Burnout monitoring and design of tailor-made plans
Institutionalization of the Occupational Health and Safety Service

5.1. Organizational Interventions Aimed at Work Structure
5.1.针对工作结构的组织干预

The following is a description of interventions that generally focus on reducing work stressors and increasing the organizational resources available to workers [79,80].
以下是对干预措施的描述，这些干预措施通常侧重于减少工作压力源和增加工人可用的组织资源[79, 80]。

• Improving job characteristics. These actions are mainly aimed at quantitative workload reduction and qualitative work improvement through two main strategies:
  提升岗位特色。这些行动主要旨在通过两个主要策略来减少工作量的减少和工作质量的提高：

  (1)

  Work redesign. This measure aims to partially change the objectives and tasks of the job while improving the quality of work by eliminating structural and/or procedural elements that interfere and generate stress [81]. It could also be considered job redesign the enrichment of jobs through the incorporation of new and more stimulating tasks that make the job more motivating and rewarding.
  工作重新设计。该措施旨在部分改变工作目标和任务，同时通过消除干扰和产生压力的结构和/或程序因素来提高工作质量[81]。它也可以被认为是工作重新设计，通过纳入新的、更具刺激性的任务来丰富工作，使工作更具激励性和回报。

  (2)

  Modification of exposure times to potential stressors. This can be completed by reducing the time in which the worker is exposed to the most stressful elements of the job (such as, for example, attention to users or patients) through job rotation, or, if necessary, by performing other tasks or activities [82,83].
  修改潜在压力源的暴露时间。这可以通过工作轮换或在必要时执行其他任务或活动来减少工人面临工作中压力最大的因素（例如对用户或患者的关注）的时间来完成[ 82, 83]。

• Humanization of schedules and implementation of work–life balance plans. This intervention involves organizing and making work schedules and shifts more flexible to allow for the reconciliation of personal and professional life [84]. In this sense, variable work shifts and long working hours exceeding 8 h should be eliminated.
  人性化的日程安排和工作与生活平衡计划的实施。这种干预包括组织和使工作时间表和轮班更加灵活，以协调个人和职业生活[84]。从这个意义上说，应该取消轮班制和超过8小时的长时间工作。
• Managers’ leadership development. Supervisor support and leadership is considered an important work resource capable of reducing burnout levels in employees. However, not all supervisors employ an adequate leadership style. In this sense, several studies have shown that authentic [54], transformational [85], and servant [86] leadership styles are related to decreased burnout and have positive effects on employees’ psychological resources [87]. For this reason, these are the leadership styles that should be developed and trained to avoid the occurrence of this syndrome. Additionally, the performance of leaders and specifically leadership behaviors should also be regularly evaluated by the individuals working with them to identify potentially adverse aspects that could trigger burnout.
  管理者的领导力发展。主管的支持和领导被认为是能够降低员工倦怠程度的重要工作资源。然而，并非所有主管都采用适当的领导风格。从这个意义上说，一些研究表明，真实的[54]、变革性的[85]和仆人式的[86]领导风格与减少倦怠有关，并对员工的心理资源产生积极的影响[87]。因此，应该发展和培训这些领导风格，以避免这种综合症的发生。此外，领导者的表现，特别是领导行为，还应该由与他们一起工作的个人定期评估，以识别可能引发倦怠的潜在不利方面。
• Use of rewards and incentives that are not only financial. Employees can be motivated by rewards that do not always need to be of a financial nature. Recognizing work well done is a very efficient way to increase workers’ motivation levels and prevent burnout [48]. As indicated previously, one of the factors causing efficiency crises, which in turn were triggers of burnout, was the lack of reinforcement and appraisal by supervisors. In addition to recognition of accomplishment, other types of rewards such as greater time flexibility (which can facilitate work–life balance) or protected time to achieve personally meaningful work goals can enhance well-being. In contrast, employing simple financial rewards may be less effective by encouraging overwork and pressure to achieve goals, which promote burnout.
  使用不仅仅是经济上的奖励和激励。员工可以通过奖励来激励，但奖励不一定是经济性质的。认可出色的工作是提高员工积极性和防止倦怠的非常有效的方法[48]。如前所述，导致效率危机、进而引发职业倦怠的因素之一是主管缺乏强化和考核。除了对成就的认可之外，其他类型的奖励，例如更大的时间灵活性（可以促进工作与生活的平衡）或受保护的时间来实现个人有意义的工作目标，可以增强幸福感。相比之下，采用简单的经济奖励可能会鼓励过度工作和实现目标的压力，从而导致倦怠，从而效果较差。
• Development of welcoming programs. Since role conflicts and ambiguities are potential triggers of burnout, it is advisable for organizations to develop welcoming processes for new workers, where the mission of the position, tasks, and objectives to be fulfilled are explained with absolute clarity and they are progressively introduced to the most stressful elements of the job, always offering support from the supervisor or other colleagues [88].
  制定欢迎计划。由于角色冲突和模糊性是职业倦怠的潜在触发因素，因此建议组织为新员工制定欢迎流程，其中绝对清晰地解释职位的使命、任务和要实现的目标，并逐步将其介绍给新员工。工作中压力最大的部分，总是得到主管或其他同事的支持[88]。
• Burnout monitoring and design of customized plans. This consists of periodically conducting surveys and measurements of workers to “monitor” the organization’s burnout levels and compare the scores of workers according to units, location, position, supervisor, etc. (e.g., [89]). The aim is basically to identify the appearance of the first symptoms, thus preventing the syndrome from becoming chronic. It is important that, in addition to the levels of burnout, the organization identifies as precisely as possible the risk factors in the work environment that may be present to eliminate or minimize them. Additionally, since the specific way in which symptoms manifest themselves and which dimension is dominant varies in each work unit, to be effective it will be necessary to design interventions specific to the causes and consequences/symptoms identified.
  倦怠监测和定制计划设计。这包括定期对员工进行调查和测量，以“监控”组织的倦怠水平，并根据单位、地点、职位、主管等比较员工的分数（例如，[89]）。其目的基本上是确定最初症状的出现，从而防止该综合征变成慢性。重要的是，除了倦怠程度之外，组织还应尽可能准确地识别工作环境中可能存在的风险因素，以消除或尽量减少这些风险因素。此外，由于每个工作单位中症状表现的具体方式以及占主导地位的维度各不相同，因此为了有效，有必要针对所识别的原因和后果/症状设计干预措施。
• Institutionalization of occupational health and safety. This intervention refers to the obligation of organizations to incorporate in their structure departments or devices in the form of agreements with other entities to ensure the health and reduction of burnout in workers [90]. This intervention translates into (e.g., [91]):
  职业健康与安全制度化。这种干预是指组织有义务以与其他实体协议的形式将部门或设备纳入其结构，以确保工人的健康和减少倦怠[90]。这种干预转化为（例如，[91]）：

  (1)

  Delivery of psychoeducational workshops on stress and burnout that can be scheduled in the same organization or by outsourcing the service.
  举办有关压力和倦怠的心理教育研讨会，可以在同一组织内安排或通过外包服务安排。

  (2)

  Counseling services for workers with work-related problems. This action can be carried out within the organization or by outsourcing the service by referring the employee to a counseling specialist.
  为有工作相关问题的工人提供咨询服务。此行动可以在组织内部进行，也可以通过将员工推荐给咨询专家来外包服务。

  (3)

  Referral to specialized health promotion services such as psychologists and medical specialists.
  转介给专门的健康促进服务机构，例如心理学家和医学专家。

5.2. Interventions Promoted by the Organization Aimed at Employees
5.2.组织针对员工推行的干预措施

This type of intervention basically aims to increase the personal resources of employees to manage stressors at work, which in turn helps to reduce burnout levels.
这种类型的干预基本上旨在增加员工的个人资源来管理工作中的压力源，从而有助于降低倦怠程度。

• Training. Through training, employees can acquire new skills and technical knowledge that increase their coping resources and improve their self-efficacy expectations. However, in addition to technical skills related to the job, organizations should plan training actions aimed at developing other types of personal and social skills that facilitate workers to implement individual strategies to promote their well-being and adjustment to the job [88,92]. Table 5 includes examples of training actions to prevent or manage burnout.
  训练。通过培训，员工可以获得新的技能和技术知识，从而增加他们的应对资源并提高他们的自我效能期望。然而，除了与工作相关的技术技能之外，组织还应该规划旨在发展其他类型的个人和社交技能的培训行动，以促进工人实施个人策略，以促进他们的福祉和对工作的适应[88, 92] 。表 5 包括预防或管理倦怠的培训行动示例。
• Strengths-based interventions. Strengths-based interventions work from the premise that people have personal resources that can be used to cope with adversity. Using strengths is intrinsically motivating and satisfying. A strengths intervention typically unfolds in three phases, as described in Table 6.
  基于优势的干预措施。基于优势的干预措施的前提是人们拥有可用于应对逆境的个人资源。利用优势本质上是一种激励和满足。优势干预通常分三个阶段展开，如表 6 所示。
• Coaching and guidance. These are non-directive methods that encourage employees to regain control of their emotional state and well-being on their own, so the coach/counselor will not “prescribe” any treatment. Instead, the coach/counselor will guide the employee to come up with (or with some assistance) coping strategies on their own [93]. This type of intervention is usually typical of secondary prevention, in the early stages of the syndrome, when it is assumed that the person still has the capacity to redirect it.
  辅导和指导。这些是非指导性方法，鼓励员工自行重新控制自己的情绪状态和幸福感，因此教练/咨询师不会“开出”任何治疗方法。相反，教练/咨询师将指导员工自己提出（或在一些帮助下）应对策略[93]。这种类型的干预通常是典型的二级预防，在综合症的早期阶段，假设患者仍然有能力改变它的方向。
• Creation of support groups. Peer and team support has always been critical in helping professionals cope with the difficulties and challenges of day-to-day life. This support encompasses a wide range of activities, including the celebration of achievements or the creation of formal support groups. In this sense, organizations should incorporate activities into work processes that are conducive to such a sense of community as dedicating time to share ideas and knowledge about how to act and deal with day-to-day professional challenges [88]. Support groups refer to any group of coworkers, whether formal (expressly created by the organization) or informal (not created by the organization but arising spontaneously) that meet regularly to exchange information, give each other emotional support and/or solve work problems. What these groups have in common is that they offer recognition for work completed (even if objectives have not been achieved), comfort, help, and companionship. The primary objective of the support groups is to reduce the professionals’ feelings of loneliness and emotional exhaustion, as well as the exchange of knowledge to develop effective ways of dealing with problems. This intervention (e.g., two hours every two weeks) is one of the most widely employed interventions for intervening on burnout and its benefits have been repeatedly demonstrated [73]. While the creation of support groups is an individual focus intervention, in many cases it is encouraged by the organization, or should be.
  创建支持小组。同伴和团队的支持对于帮助专业人士应对日常生活中的困难和挑战始终至关重要。这种支持涵盖广泛的活动，包括庆祝成就或创建正式的支持小组。从这个意义上说，组织应该将有利于社区意识的活动纳入工作流程，例如花时间分享关于如何行动和应对日常专业挑战的想法和知识[88]。支持小组是指定期聚会以交换信息、互相给予情感支持和/或解决工作问题的任何同事群体，无论是正式的（由组织明确创建的）还是非正式的（不是由组织创建的，而是自发产生的）。这些团体的共同点是，他们对已完成的工作（即使目标尚未实现）提供认可、安慰、帮助和陪伴。支持小组的主要目标是减少专业人士的孤独感和情绪疲惫，以及交流知识以制定解决问题的有效方法。这种干预措施（例如每两周两小时）是最广泛采用的倦怠干预措施之一，其益处已被反复证明[73]。虽然创建支持小组是一种以个人为中心的干预措施，但在许多情况下，组织鼓励或应该鼓励这样做。

Table 5. Examples of training actions promoted by organizations to prevent burnout.

Actions
Self-regulation and emotional management Development of other personal resources, such as resilience, self-efficacy, hope, and optimism Conflict management Work stress management Time management Job-specific technical skills Problem solving Teamwork

Table 6. Generic phases of strengths-based interventions.

1. Identification of Competencies	2. Strengths Development	3. Utilization of Strengths
They usually result in a list of the most relevant strengths. Performance appraisals and other tools such as questionnaires and strengths scales can be used for this purpose.	Organizations often set up training workshops and individual development programs in which individuals are encouraged to cultivate and refine their strengths by developing a concrete action plan.	An attempt is made to match the types of tasks to be performed with the strengths of the employees.

5.3. Individual-Focused Interventions Promoted by the Individual
5.3.由个人推动的以个人为中心的干预措施

These types of actions are initiated and determined by the workers themselves and are aimed at improving their emotional and physical state completely outside the work environment, including physical exercise, mindfulness, self-assessment and, where appropriate, psychotherapy.
这些类型的行动由工人自己发起和决定，旨在完全改善工作环境之外的情绪和身体状态，包括体育锻炼、正念、自我评估以及适当的心理治疗。

• Physical exercise. Several studies have shown the positive effect of physical activity as a moderating variable of the effects of burnout on the health of workers [94,95]. Physical exercise can be used in primary, secondary and, where appropriate, tertiary prevention.
  体育锻炼。多项研究表明，体力活动作为职业倦怠对工人健康影响的调节变量具有积极作用[94, 95]。体育锻炼可用于一级、二级预防，并在适当情况下进行三级预防。
• Mindfulness training. A systematic review [96] of various specialized databases published between 2008 and 2017 concluded that mindfulness practice is effective in reducing burnout syndrome, both in its total values and in those corresponding to its dimensions, mitigating the negative psychosomatic and emotional effects of the syndrome, and increasing other positive ones such as empathy or concentration.
  正念训练。对 2008 年至 2017 年间发表的各种专业数据库的系统回顾 [96] 得出结论，正念练习可以有效减少倦怠综合症，无论是在其总价值还是与其维度相对应的价值上，减轻该综合症的负面心身和情绪影响，并增加其他积极的方面，例如同理心或专注力。
• Self-assessment. This intervention involves the self-observation of possible signs that could point to burnout. The way to do this is, for example, by keeping a diary of stress symptoms and related events such as specific symptoms, thoughts, feelings, and ways of coping with them. On the other hand, in addition to this type of diary, it is also important to measure the degree of burnout with a properly validated test, such as those indicated in the following section, and to compare one’s own score with that of a reference group or with oneself over time.
  自我评估。这种干预包括自我观察可能表明倦怠的迹象。例如，做到这一点的方法是写日记，记录压力症状和相关事件，例如具体症状、想法、感受和应对方法。另一方面，除了这种类型的日记之外，通过适当验证的测试来衡量倦怠程度也很重要，例如下一节中指出的那些，并将自己的分数与参考组的分数进行比较或随着时间的推移与自己。
• Psychotherapy. Psychotherapeutic treatment of burnout syndrome is carried out in the most severe and serious cases (i.e., when the syndrome and its consequences are already being suffered). Psychotherapeutic treatment basically consists of developing emotional self-regulation and relaxation skills, problem solving, development of self-efficacy, and assertiveness and is generally based on the principles of cognitive-behavioral therapy [73,92]. This intervention may be funded by the organization; however, it will always be the individual him/herself who will make the decision to initiate a psychotherapy process. There are three types of techniques used to reduce burnout:
  心理治疗。倦怠综合症的心理治疗是在最严重和最严重的情况下进行的（即，当综合症及其后果已经受到影响时）。心理治疗基本上包括发展情绪自我调节和放松技能、解决问题、发展自我效能和自信，并且通常基于认知行为治疗的原则[73, 92]。这种干预可能由组织资助；然而，启动心理治疗过程的决定始终由个人自己决定。可以使用三种类型的技术来减少倦怠：

  (1)

  Cognitive techniques: these are aimed at the individual reevaluating and restructuring their appreciation and vision of stressful or problematic situations, so that they can deal with these situations more effectively. This type of technique is useful because people perceive situations subjectively and individually and, therefore, in a biased way. Cognitive techniques are aimed at identifying and modifying errors in the perception of reality to influence the emotions they provoke and the behavior they trigger.
  认知技术：这些技术旨在让个人重新评估和重组他们对压力或问题情况的认识和看法，以便他们能够更有效地处理这些情况。这种技术很有用，因为人们主观地、单独地感知情况，因此会带有偏见。认知技术旨在识别和纠正现实感知中的错误，以影响它们引发的情绪和引发的行为。

  (2)

  Physiological deactivation techniques: the aim of this type of technique is to teach the person mechanisms to control, through relaxation, the increased physiological activation and anxiety caused by stressful stimuli.
  生理失活技术：此类技术的目的是教会人们通过放松来控制由压力​​刺激引起的生理激活和焦虑增加的机制。

  (3)

  Training in healthy lifestyle habits: physical exercise, a balanced diet, and restful sleep can help to reduce the symptoms of burnout.
  培养健康的生活习惯：体育锻炼、均衡饮食和安宁的睡眠有助于减轻倦怠症状。

5.4. Individually Driven, Work-Focused Interventions
5.4.个人驱动、以工作为中心的干预措施

These interventions are also initiated and determined by workers, but in this case, they are aimed at improving the work environment.
这些干预措施也是由工人发起和决定的，但在这种情况下，它们的目的是改善工作环境。

• Time management. Employees who are at risk of burnout often feel that they lack the time to fulfill all their responsibilities or that they work long hours with no time for personal use and rest. Self-management of time consists of correctly planning one’s time by making efficient use of the time available, organizing tasks realistically, and delegating them when appropriate, as well as dedicating daily time for personal activities and recreation [79,80]. Although this intervention is promoted by each worker, to facilitate proper time management, organizations as indicated above can or should provide training and coaching actions to their workers [97].
  时间管理。面临倦怠风险的员工通常会觉得自己没有时间履行所有职责，或者工作时间很长，没有时间个人使用和休息。时间的自我管理包括通过有效利用可用时间来正确规划自己的时间，实际地组织任务并在适当的时候委派任务，以及每天将时间用于个人活动和娱乐[79, 80]。尽管这种干预措施是由每个工人提倡的，但为了促进适当的时间管理，上述组织可以或应该为其工人提供培训和指导行动[97]。
• Job crafting. Unlike job redesign (explained above), which is managed and planned by the organization, job crafting is an individual bottom-up intervention, initiated by the employees themselves, which consists of actively modifying their job (as long as the job mission is fulfilled) by reconfiguring the way they approach tasks and negotiating the job content, allowing employees to adjust their jobs to their personal knowledge, skills and abilities, and to their preferences and needs. In other words, through job crafting, the work to be performed does not change but is adjusted to experience it in a more meaningful way. These adjustments can be of four types [98] and are summarized in Table 7.
  工作制作。与由组织管理和规划的工作重新设计（如上所述）不同，工作重塑是一种由员工自己发起的个人自下而上的干预，其中包括积极修改他们的工作（只要完成工作使命）通过重新配置他们处理任务的方式和协商工作内容，允许员工根据他们的个人知识、技能和能力以及他们的偏好和需求调整他们的工作。换句话说，通过工作重塑，要执行的工作不会改变，而是会进行调整，以更有意义的方式体验它。这些调整可以有四种类型[98]，并在表 7 中进行了总结。

Table 7. Types of adjustments made with job crafting.

1. Increasing Structural Job Resources	2. Decreasing Job Demands	3. Increasing the Social Resources of Employment	4. Increased Demand for Challenges at Work
Doing what is possible to develop professional skills and learn new things on the job.	Organizing work in such a way that it does not cause too much stress, is mentally less intense, as well as avoiding emotionally complicated situations with customers and colleagues and trying not to make difficult decisions at work.	Asking, if necessary, for help and feedback about the job from the supervisor and co-workers.	When an interesting project comes up, proactively offer to work on it, when there is little to do, offer help to co-workers and ask for more responsibility from the supervisor.

5.5. Future Research 5.5.未来的研究

Evaluation research on the success or failure of intervention strategies aimed at preventing or containing burnout is stilled needed. The interventions presented in this section offer a general and broad view of how to deal with burnout. However, since this syndrome depends on and develops idiosyncratically according to personal factors as well as working conditions, future lines of research should focus on analyzing which are the most efficient interventions according to individual characteristics and situational triggers. In addition, it would be optimal to establish comparisons between different interventions aimed at both the individual and the organization level. Furthermore, it is necessary to analyze the possible interaction between interventions and whether the combination of several of them is potentiating, inhibiting, or redundant. Finally, it would also be interesting to establish longitudinal studies to detect which of these interventions are more effective in the long term.
仍然需要对旨在预防或遏制倦怠的干预策略的成功或失败进行评估研究。本节提出的干预措施提供了如何应对倦怠的一般性和广泛的观点。然而，由于这种综合症取决于个人因素和工作条件，并根据个人因素和工作条件而特殊发展，因此未来的研究方向应侧重于根据个人特征和情境触发因素分析哪些是最有效的干预措施。此外，最好对针对个人和组织层面的不同干预措施进行比较。此外，有必要分析干预措施之间可能存在的相互作用，以及几种干预措施的组合是否会增强、抑制或冗余。最后，建立纵向研究来检测哪些干预措施从长远来看更有效也很有趣。

6. Assessment and Measurement
6. 评估和测量

When it comes to assessing burnout, several tools (scales and questionnaires) have been developed and validated in different countries. These tools can be classified into two broad categories: (1) generic instruments (i.e., instruments aimed at assessing the syndrome, without differentiating by professional occupations; the main difference between these instruments is the burnout theoretical model they consider and what other aspects, if any, they evaluate), and (2) specific instruments aimed at evaluating burnout in specific occupations (e.g., nurses, psychologists, physicians) or even out of job (e.g., sports, school and parental relationships). Table 8 shows the main instruments currently available for assessing burnout.
在评估倦怠方面，不同国家已经开发并验证了多种工具（量表和问卷）。这些工具可分为两大类：（1）通用工具（即旨在评估综合症的工具，不按专业职业进行区分；这些工具之间的主要区别在于它们考虑的倦怠理论模型以及其他方面，如果任何，他们都会评估），以及（2）旨在评估特定职业（例如护士、心理学家、医生）甚至失业（例如体育、学校和父母关系）的职业倦怠的具体工具。表 8 显示了目前可用于评估职业倦怠的主要工具。

Table 8. Instruments for assessing burnout.

Generic Instruments	Specific Instruments
Maslach Burnout Inventory (MBI) Questionnaire for the Evaluation of Burnout Syndrome at Work (CESQT) Copenhagen Burnout Inventory (CBI) Oldenburg Burnout Inventory Burnout Clinical Subtypes Questionnaire (BCSQ-36/12) Burnout Assessment Tool (BAT) Shirom–Melamed Burnout Questionnaire (SMBQ)	Maslach Burnout Inventory-Human Services Survey (MBI-HSS) Brief Burnout Questionnaire Revised for nursing staff Physician Burnout Questionnaire Teacher Burnout Questionnaire Psychologist’s Burnout Inventory Burnout Questionnaire for Athletes School Burnout Inventory Parental Burnout Inventory

6.1. Generic Instruments 6.1.通用仪器

Maslach Burnout Inventory (MBI; [5]). The most widely used and validated tool for measuring burnout. At first, this tool was designed exclusively to measure burnout in personnel in the care sector and was called the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, research and epidemiological studies showed that burnout can occur in any occupation and sector of activity, and for these reasons Schaufeli et al. [99] developed the definitive tool, the MBI-GS (Maslach Burnout Inventory-General Survey), based on the previous one and applicable to all occupations and jobs. This instrument has 16 items distributed in three dimensions: emotional exhaustion, cynicism, and reduced professional fulfillment. Thus, high scores on these dimensions would be indicative of burnout. This tool has subsequently been validated in different cultural and work contexts, such as Spanish [6], Italian [100], French [101], Chinese [102], and Arabic [103], among others.
Maslach 倦怠量表（MBI；[5]）。使用最广泛且经过验证的职业倦怠测量工具。最初，该工具专门用于衡量护理行业人员的倦怠程度，被称为 Maslach 倦怠清单-人类服务调查 (MBI-HSS)。然而，研究和流行病学研究表明，职业倦怠可能发生在任何职业和活动领域，因此 Schaufeli 等人。 [99]在前一个工具的基础上开发了权威工具MBI-GS（Maslach Burnout Inventory-General Survey），适用于所有职业和工作。该工具有 16 个项目，分布在三个维度：情绪疲惫、愤世嫉俗和职业成就感降低。因此，这些维度上的高分表明倦怠。该工具随后在不同的文化和工作环境中得到了验证，例如西班牙语[6]、意大利语[100]、法语[101]、中文[102]和阿拉伯语[103]等。

Questionnaire for the Evaluation of Burnout Syndrome (CESQT; [104]). The CESQT consists of twenty items that are grouped into four dimensions: (1) enthusiasm for work: this is defined as the individual’s desire to achieve work goals because it is a source of personal pleasure. Low scores in this dimension indicate high levels of burnout; (2) psychic burnout: this is defined as the occurrence of emotional and physical exhaustion because of work; (3) indolence or the presence of negative attitudes of indifference and cynicism towards the organization’s customers; and (4) guilt: this is defined as the appearance of feelings of guilt for the behavior and negative attitudes developed at work, especially towards people with whom work relationships are established. This instrument has two different versions: the main version (CESQT), which is applied to workers who work with people (e.g., psychologists, teachers, or doctors) and the “Professional Disenchantment” version (CESQTDP), which is administered to those workers who do not work in direct contact with people. Although this tool was originally designed in a Spanish context, throughout these years the CESQT has also had a great reception and a wide development in different countries. It has been translated, adapted and validated in Germany [105], France [106], Italy [107], Portugal [108], and Poland [109]. In Anglo-Saxon literature, the use of the CESQT is regularly cited as the Spanish Burnout Inventory (SBI; e.g., [110,111]), and alludes to the theoretical model from which it starts, highlighting that among its strengths is the fact of collecting a broader vision of burnout than other instruments by including the dimension of guilt [67]. The wide dissemination of the instrument and its quality as a psychological assessment tool has favored the American Psychological Association (APA) to include it in its database of psychological tests.
倦怠综合症评估问卷（CESQT；[104]）。 CEQT由20个项目组成，分为四个维度：（1）工作热情：这被定义为个人实现工作目标的愿望，因为它是个人快乐的源泉。该维度得分低表明倦怠程度高； （2）精神倦怠：指因工作而出现情绪和身体疲惫的情况； (3) 对组织的顾客表现出懒惰或冷漠、愤世嫉俗的消极态度； (4) 内疚：这被定义为对工作中的行为和消极态度表现出内疚感，尤其是对与之建立工作关系的人。该工具有两个不同的版本：主版本 (CESQT)，适用于与人（例如心理学家、教师或医生）一起工作的工作者；以及“专业祛魅”版本 (CESQTDP)，适用于这些工作者不与人直接接触工作的人。尽管这个工具最初是在西班牙背景下设计的，但这些年来，CESQT 在不同国家也得到了广泛的认可和广泛的发展。它已在德国[105]、法国[106]、意大利[107]、葡萄牙[108]和波兰[109]进行翻译、改编和验证。在盎格鲁-撒克逊文献中，CESQT 的使用经常被引用为西班牙倦怠量表（SBI；例如，[ 110, 111]），并暗示其起始的理论模型，强调其优势之一是事实通过纳入内疚的维度来收集比其他工具更广泛的倦怠视野[67]。 该仪器的广泛传播及其作为心理评估工具的质量有利于美国心理学协会（APA）将其纳入其心理测试数据库。

Copenhagen Burnout Inventory (CBI; [112]). This scale allows the assessment of context-free burnout. It is composed of three main factors: (1) personal burnout, (2) work-related burnout, and (3) client-related burnout.
哥本哈根倦怠清单（CBI；[112]）。该量表可以评估与情境无关的倦怠。它由三个主要因素组成：（1）个人倦怠，（2）与工作相关的倦怠，（3）与客户相关的倦怠。

Oldenburg Burnout Inventory [113]. This inventory was developed to measure burnout across various occupational groups and measures two dimensions of burnout: (1) exhaustion, which is the primary symptom of burnout, and (2) disengagement from work.
奥尔登堡倦怠量表[113]。该清单旨在衡量不同职业群体的倦怠，并衡量倦怠的两个维度：(1) 精疲力尽，这是倦怠的主要症状；(2) 脱离工作。

Burnout Clinical Subtypes Questionnaire (BCSQ; [114,115]). The questionnaire consists of 36 items and measures the different properties of each clinical subtype. Each subtype consists of several facets: involvement, ambition, and overload of the frenetic type; indifference, lack of development, and boredom of the under-challenged type; and finally, neglect, lack of acknowledgement, and lack of control of the worn-out type. This questionnaire was originally developed in Spain, but recently it has been validated for other cultures such as Latvia [116] and Germany [117]. In its short version (BCSQ-12), consisting of 12 items, only one subscale of each subtype is analyzed (i.e., overload, lack of development, and neglect).
倦怠临床亚型问卷（BCSQ；[ 114, 115]）。该问卷由 36 个项目组成，衡量每个临床亚型的不同特性。每个亚型都包含几个方面：狂热型的投入、野心和超负荷；冷漠、缺乏发展、缺乏挑战性的无聊；最后，是疲惫型的忽视、缺乏承认和缺乏控制。该调查问卷最初是在西班牙开发的，但最近已在拉脱维亚[116]和德国[117]等其他文化中得到验证。在其简短版本 (BCSQ-12) 中，由 12 个项目组成，仅分析每个亚型的一个子量表（即超负荷、缺乏发展和忽视）。

Burnout Assessment Tool (BAT; [118]). This tool is based on an alternative, comprehensive conceptualization of burnout, and includes all relevant elements that are associated with burnout. The questionnaire contains 33 items and consists of the BAT-C and BAT-S. The BAT-C assesses the four core dimensions: (1) exhaustion, (2) cognitive, (3) emotional impairment, and (4) mental distance). The BAT-S assesses two atypical secondary dimensions that often co-occur with the core symptoms: (1) psychological complaints, and (2) psychosomatic complaints.
倦怠评估工具（BAT；[118]）。该工具基于倦怠的另一种全面概念化，并包括与倦怠相关的所有相关元素。问卷包含33个项目，由BAT-C和BAT-S组成。 BAT-C 评估四个核心维度：(1) 疲惫、(2) 认知、(3) 情绪障碍和 (4) 心理距离。 BAT-S 评估两个通常与核心症状同时出现的非典型次要维度：(1) 心理主诉，(2) 心身主诉。

Shirom–Melamed Burnout Questionnaire (SMBQ; [119]). The instrument comprises 22 items which consists of the following sub-scales: (1) emotional exhaustion, (2) physical fatigue, (3) cognitive weariness, (4) tension, and (5) listlessness. Later development of the instrument resulted in the Shirom–Melamed Burnout Measure (SMBM; [120]), which included 14 item divided in three subscales; (1) physical fatigue, (2) emotional exhaustion, and (3) cognitive weariness.

6.2. Specific Instruments

Maslach Burnout Inventory-Human Services Survey (MBI-HSS; [5]). This is a 22-item survey, applicable to human services jobs, for instance, clergy, police, therapists, social workers, medical professionals. The MBI-HSS (MP), adapted for medical personnel, and MBI-Educators Survey (MBI-ES), adapted for educators, are available online at https://www.mindgarden.com/117-maslach-burnout-inventory-mbi (accessed on 26 December 2022).

Brief Burnout Questionnaire Revised for nursing staff [121]. This instrument is an alternative tool to the MBI-HSS (MP). The questionnaire comprises 21 items that evaluate not only the syndrome itself, but also its antecedents and consequences. These items are gathered into four factors: (1) job dissatisfaction, comprising four items; (2) social climate, made up of three items; (3) personal impact, made up of four items, and (4) motivational exhaustion, comprising four items.

Physician Burnout Questionnaire-PhBQ [122]. This is another alternative instrument to the MBI-HSS (MP). The PhBQ contains 17 items and includes four subscales: burnout syndrome (PhBSS), antecedents (PhBAS), consequences (PhBCS), and personal resources (PPRS).

Teacher Burnout Questionnaire [123]. This questionnaire examines the burnout of teachers and is based on Maslach, Jackson and Leiter’s original instrument ([28]). The questionnaire comprises 14 items.

Psychologist’s Burnout Inventory—PBI [124]. This instrument measures four factors related to burnout among psychologist: control (three items assessing control over work activities, schedule, and decisions), overinvolvement (three items assessing feelings of responsibility for and spending time thinking about or dealing with clients), support (three items assessing emotional and instrumental support from colleagues), and negative client behaviors (six items assessing the experience of aggressive, dangerous, or threatening client behaviors). A revision of this instrument (PBI-R) was developed by Rupert et al. [125].

Athlete Burnout Questionnaire [126,127]. This tool is adapted to sport environments, and it is composed of 15 items organized in three dimensions: emotional/physical exhaustion, reduced sense of accomplishment and devaluation.

School Burnout Inventory-SBI [128]. This inventory comprises nine items grouped in three dimensions: (a) exhaustion at school, (b) cynicism toward the meaning of school, and (c) sense of inadequacy at school.

Parental Burnout Inventory [129]. This instrument assesses parental burnout syndrome, including exhaustion, distancing, and inefficacy.

6.3. Future Research

The main objection that could be made to the questionnaires presented above is that they are self-reported measures that focus especially on quantifying the burnout factors (emotional exhaustion, cynicism, and professional efficacy). However, since the burnout phenomenon is complex, more tools should be designed that consider both the antecedents and the physical and psychological consequences of burnout, thus offering a more global vision of this syndrome. As noted by Shirom [130], burnout measures should be analyzed within the framework of theoretical models that also consider causes and effects of burnout, as well as correlates. This type of instrument would, in turn, allow the development of more individualized and personalized interventions and treatments.

Moreover, different theoretical conceptualizations of burnout have led to the proliferation of a wide range of measurement instruments, usually comprising several dimensions. To what extent these instruments overlap or encompass different constructs remains to be seen. As a consequence, the burnout definition applied translates into considerably different burnout prevalence estimates in the literature. Furthermore, while some researchers use a unidimensional measure of burnout, others focus on one or more dimensions. Additionally, most instruments also lack a clinically validated threshold or cutoff values for burnout diagnosis.

Future lines of research could focus on examining the relationships between self-report measures of burnout and objective biological markers (i.e., salivary cortisol) to identify which questionnaires have the highest predictive capacity for these biomarkers. In addition, adaptation and validation of the main measurement instruments to different cultural contexts is still an ongoing need.

7. Special Issue on “Occupational Stress and Health: Psychological Burden and Burnout”

This Special Issue includes 21 papers which bring together recent developments and studies in this field. It aims to provide a comprehensive approach to occupational health from a broad range of perspectives. The results are of use for both researchers and practitioners. Undoubtedly, the COVID-19 pandemic has impacted organizational contexts increasing the risk of stress and burnout. Burnout and stress are analyzed from different perspectives with a focus on specific occupational groups in diverse countries from several continents. Post-Traumatic Stress Disorder (PTSD) in the Military Police of Rio de Janeiro (Brazil) is investigated as well as its correlations with socio-demographic and occupational variables [131]. Gender and age differences in personal discrimination experience, burnout, and job stress among physiotherapists and occupational therapists are examined in South Korea [132]. Nurses in South Korea are further studied with respect to emotional labor, burnout, turnover intention, and medical error levels within the previous six months [133]. Healthcare workers are also the focus of another study in Japan [134], which concludes that the number of physical symptoms perceived are positively related to burnout scores. Moreover, job strain and work–family conflict are associated with an increased risk of burnout, while being married, being a parent, and job support are associated with a decreased risk of burnout. In Spain, the relationship between burnout, compassion fatigue, and psychological flexibility is analyzed in geriatric nurses [135] as well as the prevalence of emotional exhaustion, depersonalization, and possible non-psychotic psychiatric disorders in nurses during the COVID-19 pandemic [136]. In Germany [137], teachers and social workers are surveyed following a model derived from the Job Demands–Resources theory to predict effects of strains on burnout, job satisfaction, general state of health, and life satisfaction. While some professionals working in the educational sector are burned out, other develop resilience, and thus it is important to identify antecedents and profiles (e.g., support), as evidenced by another study carried out in Spain [138]. Burnout and job satisfaction are additionally examined in a sample of music therapists in Spain [139]; a higher risk of burnout is associated with working longer hours in a palliative care setting.

Although a variety of instruments have been developed and validated in different contexts, new reliable and more specific tools are timely and highly valuable to better operationalize and understand job burnout. In this line, a new scale to gauge the balance between risks and resources (Balance) is developed in three French-speaking countries and then longitudinally tested in several English-speaking countries [140]. Another instrument is developed to evaluate job resources and further explore the relationship between resources and psychological detachment [141]. To assess the added value of a joint use of two tools, Leclercq et al. [142] compare the diagnostic accuracy of a structured interview guide and a self-reported questionnaire, finding differences in sensitivity and specificity with implications in diagnosis and treatment. A systematic review analyses both subjective and objective measurement methods to study fatigue, sleepiness, and sleep behavior in seafarers [143]. Related to new ways to measure and study stress, the “Study on Emergency physicians’ responses Evaluated by Karasek questionnaire” (SEEK) Protocol [144] presents the design of a study protocol to examine well-being in emergency healthcare workers in order to assess and determine Karasek scores in a large sample size of emergency healthcare workers and evaluate whether there is a change in work perception (both in the short and the long term). Additionally, this protocol will allow us to explore Karasek’s associations with some biomarkers of stress and protective factors.

The identification of mediators is another promising line of research. Mérida-López et al. [145] explore in a sample of pre-service teachers in Spain the mediator role of study engagement in the relationship between self- and other-focused emotion regulation abilities and occupational commitment. A moderated-mediation model is used in China to examine the effect of perceived overqualification on emotional exhaustion, the mediating role of emotional exhaustion in the relationship between perceived overqualification and creativity, and the moderating role of pay for performance in the perceived overqualification–emotional exhaustion relationship. Occupational stressors are studied in China as mediators in the psychological capital–family satisfaction link [146]. In Brazil, the moderating role of recovery from work stress is explored in the relationship between flexibility ideals and patterns of sustainable well-being at telework [147].

Last, a growing avenue of research is devoted to leadership. Leaders’ behaviors have important consequences for both employees and organizations. In this Special Issue, ethical leadership is investigated in South Korea with respect to emotional labor and emotional exhaustion [148]. Identity leadership, team identification, and employee burnout are examined in 28 countries within the Global Identity Leadership Development (GILD) project [149]. Security-providing leadership is proposed to be a job resource to prevent employee burnout [150].

8. Conclusions

In this review, we have analyzed what burnout is, what are its main dimensions, what models have been proposed for the description and explanation of this syndrome, what are its antecedents and consequences, what tools allow its evaluation and how it can be intervened both at the organizational and individual level. We also present our critical vision, indicating how each specific aspect should be studied today, the future lines of research on burnout, and what the future lines of intervention in organizations should be. The most recent research published in the Special Issue on “Occupational Stress and Health: Psychological Burden and Burnout”, 21 papers, is summarized according to main areas.

There is no doubt that burnout is currently a growing concern for individuals, organizations, and society. For example, among physicians, this syndrome has reached epidemic proportions around the world, accompanied by alarming levels of depression and suicidal ideation [151]. Thus, people suffering from burnout report feeling exhausted throughout the day, and not only during their working day. In fact, just thinking about work before getting up in the morning leaves them exhausted.

Work environments with excessive work schedules and high levels of demands, as well as the need to prove that one is worthy of a certain position, leave workers emotionally drained, cynical about work, and with a low sense of personal accomplishment. Moreover, the pressure does not end with the end of the workday; new technologies, mobile devices and the lack of boundaries prevent disconnection and the necessary recovery from work.

However, burnout is not an inevitable syndrome; it can be prevented before it appears and treated during its development. Nonetheless, interventions often focus on individuals rather than organizations, even though the main causes of this syndrome are organizational factors such as work overload or role ambiguity. As Shanafelt and Noseworthy [88] point out, organizations should regularly assess the well-being of their workers, both quantitatively and qualitatively, and consider it a key performance indicator. In fact, it is likely that the relationship between burnout and job performance is underestimated because burned-out workers adopt “performance protection” strategies to maintain priority tasks and neglect low-priority secondary tasks such as, for example, dealing kindly with customers, clients, or patients [152]. In this way, evidence of the syndrome is masked until critical points are reached.