LAUSR

Dear Editor, We followed with interest the correspondence between Laurent et al. and Hawryluck and Brindley about estimates of the prevalence of burnout [1]. Of course, we do agree that burnout remains poorly defined and that relying on the Maslach Burnout Inventory (MBI) raises unresolved issues [2]. Nevertheless, in a study published in the main French journal of anesthesia, involving more than 1500 anesthetists, nurses, and intensivists, we observed that values in the three MBI subscales were correlated with the number of affected dimensions and closely linked with many markers of illbeing [3]. Moreover, a Gaussian-like distribution (Fig. 1) was testament to the continuous and progressive nature of burnout, and this paradigm contradicted the usual dichotomic handling. Our work included the Fast Alcohol Consumption Evaluation (FACE) and the Harvard Department of Psychiatry and National Depression Screening Day Scale (HANDS). According to the thresholds proposed by Maslach [3], 67% of the 241 intensivists were in burnout. Depression was observed in 36% of them, 6% were addicted to alcohol, and 4% were addicted to drugs or chemicals. Of interest, 6% had high scores in the three MBI dimensions, with a strong correlation between scores and conflicts, sleep disturbances, depression, psychiatric history, and suicidal ideations. Addiction or road accidents after a nightshift increased with the number of dimensions involved without reaching statistical significance (Fig. 1). Although the MBI cannot directly tell investigators when exhaustion or depersonalization reach clinically relevant levels, it should definitely raise the alarm when the three dimensions of the inventory together reach the thresholds suggested by Maslach. This condition was related to alarming mental and health counterparts in our cohort (Fig. 1). So, rather than ever inflating the rates of detected burnout (the “bubble” rightly highlighted by Laurent et al.), investigators should focus on new definitions of cutoff values, pointing to a subpopulation at risk not only of burnout but also meaningful complications. Moreover, to prevent severe deterioration [5], we believe caregivers should perform the MBI at least once a year as part