Association between burnout and circulating levels of pro- and anti-inflammatory cytokines in schoolteachers

Objective rnout syndrome has been associated with an increased risk of cardiovascular disease. The physiological mechanisms potentially involved in this link are underexplored. Knowing that a chronic low-grade systemic inflammatory state contributes to atherosclerosis, we investigated circulating cytokine levels in relation to burnout symptoms. s died 167 schoolteachers (median, 48 years; range, 23–63 years; 67% women) who completed the Maslach Burnout Inventory with its three subscales emotional exhaustion (EE), lack of accomplishment (LA), and depersonalization (DP). Levels of the proinflammatory cytokine tumor necrosis factor (TNF)-α and of the anti-inflammatory cytokines interleukin (IL)-4 and IL-10 were determined in fasting morning plasma samples. The TNF-α/IL-4 ratio and the TNF-α/IL-10 ratio were computed as two indices of increased inflammatory activity. Analyses were adjusted for demographic factors, medication, lifestyle factors (including sleep quality), metabolic factors, and symptoms of depression and anxiety. s levels of total burnout symptoms aggregating the EE, LA, and DP subscales independently predicted higher TNF-α levels (ΔR2=.024, P=.046), lower IL-4 levels (ΔR2=.021, P=.061), and a higher TNF-α/IL-4 ratio (ΔR2=.040, P=.008). Higher levels of LA predicted decreased IL-4 levels (ΔR2=.041, P=.008) and a higher TNF-α/IL-4 ratio (ΔR2=.041, P=.007). The categorical dimensions of the various burnout scales (e.g., burnout yes vs. no) showed no independent relationship with any cytokine measure. sion t was associated with increased systemic inflammation along a continuum of symptom severity rather than categorically. Given that low-grade systemic inflammation promotes atherosclerosis, our findings may provide one explanation for the increased cardiovascular risk previously observed in burned-out individuals.