How stress affects mental health: from burnout to depression

Good mental health is a kind of puzzle comprised of both of genetic and environmental pieces. Some are a given, such as the greater or lesser genetic predisposition towards mental health problems; others build up over time according to your environment, family situation, relationships, financial situation, work and trauma or lack of it. An amalgam of factors define our mental health, but not all play the same role. Stress at work, for example, is more likely to lead to depression than other factors and, according to a study published in the journal Molecular Psychiatry, if it were minimized, depressive disorders would be reduced by 18%.

Celso Arango, head of Psychiatry at the Gregorio Marañón Hospital in Madrid and co-author of the study, explains that stress is initially positive for the body. It is a reaction to danger or, at least, trouble and the human body is used to it. But to be positive, it has to be measured. “Stress increases cortisol, which is neurotoxic,” explains Arango, who is also president of the Spanish Society of Psychiatry. “Chronic, sustained stress ends up producing insomnia, anxiety and depression.”

Why mental illness is preventable

Reviewing the available science on the role of modifiable risk factors, the study calculates what percentage of any one disorder could be avoided if a key risk factor was eliminated. In each case, it depends on both the condition and the circumstances. It was calculated, for example, that avoiding “childhood adversity” such as abuse, would reduce cases of schizophrenia by 38%. And if enough physical exercise was taken consistently, “cases of Alzheimer’s would be reduced by 15% later in life,” says Joaquim Raduà, a researcher at the August Pi i Sunyer Biomedical Research Institute (Idibaps) at Barcelona’s Clinic Hospital and co-author of the study.

Both Raduà and Arango admit the research has its limitations. “The effectiveness in the real world of specific preventive interventions targeting these risk factors must be demonstrated,” they admit. But Raduà adds that the study serves to demonstrate that social factors only partly explain mental health problems. “Sometimes, there is a tendency to reduce the responsibility of all mental disorders to social issues and this is not accurate; genetics, the environment and the interaction between the two are at play.” At the same time, Raduà insists that “if we could act on these factors, cases could be avoided.”

Meanwhile, Arango admits that there is a “utopian” element to the study because the risk factors cannot be completely eliminated, though they can be minimized. “If we managed to reduce occupational stress by 50%, there would be 8% less depressive pathology,” he says.

Stress is undoubtedly bad for health. In fact, the World Health Organization has already included burnout syndrome in the latest update of the International Classification of Diseases. Toni Corominas, member of the Board of Directors of Catalonia’s umbrella mental health organization Clúster de Salud Mental de Cataluña, and director of Vic University’s Mental Health department, explains that the main symptoms of burnout are threefold: “On the one hand, there is emotional and physical fatigue, such as a feeling of burden and exhaustion when confronted with the demands of the task; there is also depersonalization, meaning work is done in a detached and impersonal manner because the person does not identify with his or her role; and, thirdly, there is a lack of personal fulfillment at work.”

Incipient burnout can slide into anxiety disorder or depression, Corominas explains, adding that, aside from these main symptoms, there are cumulative signs: “These start with denial, when it is difficult to talk about the stress, because there is still a stigma attached to admitting you’re not feeling great,” he says. “And then you get into those behaviors that complicate things further: instead of talking, you become passive, you don’t value new opportunities as a motivating factor, and you go down that slippery slope.”

Corominas describes how this, in turn, leads to depression. “Other symptoms such as altered sleep patterns, appetite or libido, fatigue and altered performance start to emerge,” he says. “This scenario, which could initially be reactive [to the work situation], can turn into a major depression: the symptoms are aggravated by a sense of hopelessness and helplessness, as you don’t see any solution.”

Prevention

This gradual descent into depression can be prevented if you can catch it in time. “When you notice that you have a problem, you have to initiate an assertive conversation with your superiors or colleagues,” says Corominas. “You have to create meeting spaces to analyze what is happening.” Providing this is possible, of course. According to Arango, temporary breaks, friendly working environments and facilities to reconcile the family-work balance are just some of the options for improving the management of work-related stress.

Companies, for their part, still have some way to go, says Corominas, although they have become more aware of stress as an issue. “It’s the great unfinished business.” Through the mental health umbrella association, Clúster de Salud Mental, experts have developed guides on anxiety management, dealing with stress, emotional management and tackling mood disorders and addictive behaviors.

Besides withdrawal and sleep disruption, Corominas flags up other warning signs that work-related stress is kicking in, one being the “magnification of problems” and “the feeling of guilt, when you feel to blame for everything that’s going wrong. Be careful with guilt,” he adds, “because, sometimes, when you are depressed, it is just your mind playing tricks on you.”