Factors associated with symptom severity in stress-induced exhaustion disorder: cohort characterization and cross-sectional correlations

Sean Arthur Cully; Klara Hatinova; Jakob Clason van de Leur; Malin Björnsdotter

doi:10.3389/fpsyt.2025.1548967

Factors associated with symptom severity in stress-induced exhaustion disorder: cohort characterization and cross-sectional correlations

Front Psychiatry. 2025 Jun 16:16:1548967. doi: 10.3389/fpsyt.2025.1548967. eCollection 2025.

Authors

Sean Arthur Cully¹, Klara Hatinova², Jakob Clason van de Leur³, Malin Björnsdotter^{4

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Affiliations

¹ Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
² University of Oxford, Department of Pharmacology/Queen Mary University London, Barts and The London School of Medicine and Dentistry, Gothenburg, Sweden.
³ Department of Psychology, Uppsala University, Uppsala, Sweden.
⁴ Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Center for Cognitive and Computational Neuroscience (CCNP), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁶ Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Abstract

Introduction: Chronic stress-related conditions such as burnout and exhaustion disorder (ED) constitute a significant and growing individual and societal burden. Still, the long-term interactions between symptoms and key risk factors, including brain structure and function, remain poorly understood. To address this knowledge gap, we initiated the PROMUS project, a large-scale longitudinal brain imaging study of 350 participants on sick leave for ED in Sweden.

Methods: Here, we report baseline cohort (n=300) characteristics and cross-sectional associations between symptom severity, primarily measured using the Shirom-Melamed Burnout Questionnaire (SMBQ), and demographic, occupational, psychiatric, psychological, and lifestyle factors assessed using online questionnaires.

Results: Our findings revealed significant associations between symptom severity and multiple factors, most notably depression, anxiety, sleep disturbances, quality of life, dissociation, psychological inflexibility, intolerance of uncertainty, self-efficacy, alexithymia, trauma, gratitude, educational background, emotional stability, household demands, Attention Deficit/Hyperactivity Disorder symptoms, autistic traits, perfectionism, and physical activity.

Discussion: These findings support previous research linking persistent stress conditions to a spectrum of demographic, occupational, psychiatric, psychological, and lifestyle measures. The results also add to the understanding of targetable ED symptoms and risk factors and set the direction for brain imaging analyses and longitudinal assessments in this cohort.

Keywords: burnout; clinical burnout; exhaustion; exhaustion disorder; psychological factors; stress.