Cognitive function in clinical burnout: A systematic review and meta-analysis

Figures & data

Figure 1. Flow chart of the study selection process.

Table 1. Characteristics of included studies.

Study	Participants										Comorbid depression excluded	Matching criteria ^a	Country
	Clinical burnout						Healthy controls
	n	Mean age	Gender	Burnout score	Diagnosis	Disease duration	n	Mean age	Gender	Burnout score
Ellbin et al. (2018)	93	44	69F, 24M	5.27 (SMBQ, median)	ED	Nr	111	43	72F, 39M	Nr	No	A, G, E	Sweden
Eskildsen et al. (2015)	59	44.4	50F, 9M	24.39 (PSS)	Mental health problems due to work-related stress	Nr	59	44.9	50F, 9M	10.32 (PSS)	Yes	A, G, E	Denmark
Jonsdottir et al. (2013)	33	46.3	18F, 15M	70% > 4.0 (SMBQ)	ED	Nr	37	46.9	26F, 11M	3% > 4.0 (SMBQ)	No	None	Sweden
Krabbe et al. (2017)	25	43.6	18F, 7M	5.9 (SMBQ)	ED	Nr	25	43	18F, 7M	Nr	No	A, G	Sweden
Nelson et al. (2021)	103	43.3	88F, 15M	4.87 (SMBQ)	ED	Nr	58	43.7	47F, 11M	2.47 (SMBQ)	No	A, G	Sweden
Olsson et al. (2010)	54	41.9	54F	4.39 (PBS)	ED	22 > 2 years 7 > 1 year 7 < 1 year 18 Nr	19	39.6	19F	2.99 (PBS)	Yes	A, G	Sweden
Oosterholt et al. (2012)	16	40.2	8F, 8M	UBOS: EE: 3.88 D: 2.30 PA: 4.03	USD	Nr	16	41.2	8F, 8M	UBOS: EE: 1.34 D: 0.70 PA: 4.69	Yes	A, G, E	Netherlands
Oosterholt et al. (2014)	33	41.9	15F; 18M	UBOS: EE: 4.65 D: 3.46 PA: 3.50	USD	Range 4–62 days	30	38.9	14F, 16M	UBOS: E: 1.07 D: 0.79 PA: 4.59	Yes	A, G, E	Netherlands
Rydmark et al. (2006)	29	47.8	29F	Nr	Job stress-induced depression	Mean days on sick-leave: 211	28	47.6	28F	Nr	No	A, G, E	Sweden
Sandström et al. (2005)	67	43	67F	Nr	Chronic burnout	Min sick-leave 3 months	15	39	15F	Nr	No	A, G, E	Sweden
Savic et al. (2018)	48	38.1	29F, 19M	3.9 (MBI-GS)	ED	1.5-3.5 years	80	31.8	47F, 33M	2.7 (MBI-GS)	Yes	None	Sweden
Skau et al. (2021)	20	47.5	16F, 4M	Nr	ED	8–99 months	20	39.3	12F, 8M	Nr	No	None	Sweden
van Dam et al. (2011)	40	44.2	24F, 16M	UBOS: EE: 4.9 D: 3.7 PA: 3.3	Work-related neurasthenia /USD	Nr	40	45.4	23F, 17M	UBOS: EE: 0.8 D: 0.7 PA: 4.8	Yes	A, G, E	Netherlands
van der Linden et al. (2005)	13	47^b	Nr	UBOS: EE: 4.6 D: 3.7 PA: 3.7	Clinical burnout	Nr	14	47^b	Nr	UBOS: EE: 0.5 D: 0.4 PA: 3.9	No	None	Netherlands
van Luijtelaar et al. (2010)	13	48.2	4F, 9M	UBOS: EE: 4.7 D: 4.0 PA:1.7	USD	Nr	13	48.2	4F, 9M	Nr	Yes	A, G	Netherlands
Öhman et al. (2007)	19	39.2	13F, 6M	5.59 (SMBQ)	Chronic stress	Sick-leave period of 3–24 months	19	39.9	13F, 6M	2.33 (SMBQ)	No	A, G, E	Sweden
Österberg et al. (2009)	65	48.2	46F, 19M	4.6 (MBI-GS)	ED	90% > 85 days of sick leave	65	47.9	46F, 19M	Nr	No	A, G, E	Sweden

Note. A = age; D = depersonalization; E = education; ED = exhaustion disorder; EE = emotional exhaustion; F = female; G = gender; M = male; MBI-GS = Maslach Burnout Inventory – General Survey, Nr = Not reported; PA = personal accomplishment; PBS = Pines’ Burnout Scale; PSS = Perceived Stress Scale; SMBQ = Shirom-Melamed Burnout Questionnaire; UBOS = Utrechtse Burnout Scale; USD = undifferentiated somatoform disorder.

^a Age, gender and/or education; additional criteria may also have been used.

^b Total sample

Table 2. Study-level moderators of overall cognitive function.

Moderator	No. of studies (effect sizes)	Summary effect				Test of moderation
		Hedges’ g (95% CI)	t	df	p	F	df	p
Diagnosis						2.4	2, 6.5	.17
Exhaustion disorder	8 (75)	−0.30 (−0.42 to −0.17)	5.7	6.7	<.001
Undifferentiated somatoform disorder	4 (28)	−0.27 (−0.72 to 0.18)	2.0	2.8	.15
Other	5 (73)	−0.48 (−0.67 to −0.30)	7.4	3.8	.002
Comorbid depression						0.3	1, 12.3	.58
Excluded	7 (48)	−0.31 (−0.48 to −0.14)	4.5	5.7	.005
Included	10 (128)	−0.36 (−0.50 to −0.22)	5.8	8.4	<.001
Matched controls						2.4	1, 4.4	.19
Yes	13 (141)	−0.31 (−0.41 to −0.20)	6.2	11.3	<.001
No	4 (35)	−0.46 (−0.76 to −0.17)	5.2	2.8	.02

Note. CI = confidence interval

Figure 2. Analyses of individual cognitive domains. Note. Standardised mean differences between patients with clinical burnout and healthy controls across broad (square) and narrow (circle) cognitive domains. Negative effect sizes indicate impaired performance in the clinical burnout group. k denotes the number of studies included in the analysis. CI = confidence interval.

Table 3. Domain-specific moderators of cognitive test performance.

Moderator	No. of studies (effect sizes)	Summary effect				Test of moderation
		Hedges’ g (95% CI)	t	df	p	F	df	p
Episodic memory
Stimulus mode						0.09	1, 5	.78
Verbal	9 (21)	−0.39 (−0.63 to −0.15)	4.0	6.1	.01
Non-verbal	5 (11)	−0.32 (−0.99 to 0.35)	1.5	3.2	.23
Memory type						12.0	2, 1.4	.13
Immediate	9 (22)	−0.29 (−0.51 to −0.08)	3.3	6.3	.02
Delayed	7 (10)	−0.42 (−0.81 to −0.03)	2.8	4.5	.04
Prospective	2 (2)	−1.01 (−1.76 to −0.25)	16.9	1.0	.04
Short-term and working memory
Type of assessment						0.01	1, 5.0	.94
Traditional	8 (17)	−0.36 (−0.50 to −0.22)	6.2	6.4	<.001
Computerised	4 (7)	−0.34 (−1.10 to 0.44)	1.4	2.9	.25
Executive function
Stimulus mode						0.002	1, 4.8	.97
Verbal	12 (30)	−0.40 (−0.59 to −0.20)	4.5	9.2	.001
Non-verbal	5 (13)	−0.39 (−0.87 to 0.09)	2.7	2.8	.08
Outcome type						2.5	1, 11.3	.14
Performance	11 (25)	−0.31 (−0.52 to −0.10)	3.3	9.5	.008
Time	10 (18)	−0.49 (−0.69 to −0.29)	5.9	6.4	<.001
Type of assessment						7.6	1, 5.8	.03
Traditional	5 (8)	−0.57 (−0.82 to −0.32)	7.2	3.0	.005
Computerised	11 (35)	−0.31 (−0.48 to −0.13)	4.0	9.2	.003
Attention and processing speed
Stimulus mode						1.8	1, 9.2	.22
Verbal	7 (28)	−0.31 (−0.59 to −0.03)	2.9	4.9	.03
Non-verbal	13 (24)	−0.49 (−0.68 to −0.30)	5.8	9.2	<.001
Outcome type						0.01	1, 13.9	.91
Performance	11 (24)	−0.44 (−0.62 to −0.26)	5.6	7.9	<.001
Time	12 (28)	−0.42 (−0.67 to −0.18)	4.0	8.6	.004
Type of assessment						3.0	1, 11.7	.11
Traditional	9 (16)	−0.55 (−0.78 to −0.32)	6.1	5.3	.001
Computerised	11 (36)	−0.33 (−0.54 to −0.13)	3.8	8.8	.005

Note. CI = confidence interval.

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