It’s personal: Job stress, burnout, and the heart
The workplace epidemic of burnout illustrates the interconnectedness of our minds and hearts. For me, this exploration is deeply personal. For years, I wrestled with the debilitating effects of burnout without even knowing its name. It cast a long shadow over my health, strained my relationships, and brought my career to the precipice of ruin.
This personal battle with burnout is why, in 2020, I cofounded the Ending Clinician Burnout Global Community and organised the world’s first global summit dedicated to ending clinician burnout, bringing together over a thousand participants from forty-three countries. This profound experience now fuels the second half of my career, a journey dedicated to combating burnout in the workplace and its insidious effects on individuals and our collective well-being and promoting human flourishing.
In the context of Engel’s “bio-psychosocial model,” which reminds us of the integration of life at all levels, our physical health is intricately intertwined with the environment we find ourselves in. Including our workplaces and the impact of job stress on our hearts, these environmental factors deserve discussion in this chapter. Beginning in 1985, a Whitehall II study, which followed over ten thousand British civil servants for over twenty years, led to a striking discovery (Marmot et al. 1991). It revealed a correlation between workers’ job satisfaction—higher among higher social class members, including leaders and administrators than workers—and the risk of coronary heart disease. Higher job satisfaction levels were linked with healthier hearts. Conversely, high levels of job-related stress were associated with an increased risk of heart disease.
The demanding nature of certain emotionally or physically demanding occupations, excessive workload, long hours, and poor work-life balance all contribute to chronic stress. Another study published in the Journal of Occupational Health Psychology found that individuals with high job strain, characterized by high demands and low control over their work, had a 23 percent higher risk of developing heart disease than those with low job strain (Kivimäki et al. 2012).
However, the impact of job stress goes beyond traditional everyday stress. Burnout, characterised by a personal sense of ineffectiveness at work, a lost sense of meaningful personal connection, and chronic physical and emotional exhaustion resulting from prolonged exposure to work-related stressors, has emerged as a concern in the modern workplace that has reached epidemic levels.
In 2019, the World Health Organization (WHO) recognised burnout as an occupational phenomenon and included it in the International Classification of Diseases (ICD-11) due to its public health impact (2019).
Many studies suggest a link between burnout and a higher risk of cardiovascular diseases. For instance, a study in Psychosomatic Medicine (Toker et al. 2012) indicated that individuals with burnout had a statistically higher risk of heart problems, including coronary heart disease and stroke. However, this increased risk was relatively modest.
The study found that of 8,838 participants, only 1.05 percent experienced a coronary heart disease (CHD) event over an average follow-up period of 3.6 years.
Notably, the most significant difference was observed in the highest quintile of burnout, where the absolute risk reduction compared to the lower four quintiles was about 0.7 percent over eighty months. This means that while there is an association between high burnout and CHD events, the overall impact is relatively small. Regarding how burnout affects the heart, the physiological mechanisms are similar to those of chronic stress. This includes inflammation, an overactive nervous system, and increased cardiovascular reactivity.
However, lay readers must understand that these findings represent one piece of a larger puzzle. Burnout can be a contributing factor to heart disease, but it’s not the sole cause of these problems. The overall risk to any individual from burnout alone is relatively low, and it’s just one of many factors that can affect cardiovascular health.
In a review article titled “Association between Work-Related Stress and Coronary Heart Disease: A Review of Prospective Studies through the Job Strain, Effort-Reward Balance, and Organizational Justice Models,” Sara and her colleagues bolstered the link between burnout and coronary artery blockages (2018). Their review of prospective studies examining the correlation between work-related stress and cardiovascular disease yielded an unequivocal conclusion.
Substantial evidence exists indicating that work-related stress, particularly in individuals confronting high job demands with inadequate recognition or rewards, heightens the risk of coronary heart disease. This underscores the fact that when individuals grapple with overwhelming work-related pressures without commensurate acknowledgment or compensation, it harms their heart health.
These findings reinforce the importance of acknowledging and addressing burnout for individual well-being and the health of our collective hearts. They emphasise the pressing need for holistic approaches that recognize the intricate interplay between our mental and physical health, particularly within the demanding context of the modern workplace.
Anxiety, panic, and the heart
In Anxiety RX: A New Prescription for Anxiety Relief—rom the Doctor Who Created It, Dr Russell Kennedy shares insights into the relationship between anxiety and its physical repercussions (2020). He explains that while individuals with anxiety disorders grapple with persistent worry and fear, those with panic disorders face sudden, intense bouts of dread, often accompanied by a range of physical symptoms.
Dr Kennedy described to me how symptoms such as heart palpitations, increased heart rate, and chest pain are not merely incidental but central to the anxiety experience. These distressing physical manifestations not only heighten the overall burden of anxiety on the individual, but at times, their severity can lead to unnecessary and costly medical evaluations.
Research has shown that people with anxiety disorders are at increased risk of developing cardiovascular diseases (Celano et al. 2015; Celano et al. 2016).
A 2016 meta-analysis—a study summarising results of many other studies—reviewed thirty-seven studies, including more than 1.5 million people, and found that people with anxiety have a 52 percent higher chance of developing heart disease than those without anxiety (Batelaan et al. 2016). Importantly, this increased risk remained even when other common risk factors for heart disease were considered, suggesting that anxiety can cause heart disease.
The impact of anxiety on the heart is not limited to coronary artery disease. It can also contribute to other cardiovascular conditions, such as high blood pressure and irregular heart rhythms.
In my cardiology clinic, I have encountered numerous patients like Mark, who suffer from anxiety disorders. Mark frequently experienced rapid heartbeat, shortness of breath, chest tightness, and a sense of impending doom. Through a careful history and a few diagnostic tests, we ruled out any underlying heart conditions. We were able to quickly refocus our attention squarely on alleviating his panic and anxiety.
Anxiety and panic can be effectively managed with a combination of therapeutic approaches and lifestyle modifications. Cognitive- behavioral therapy (CBT) is a treatment modality that helps individuals develop coping mechanisms to reduce anxiety symptoms. Relaxation techniques, including mindfulness and deep-breathing exercises, help us manage anxiety by promoting a sense of calm and regulating the stress response.
In addition to these psychological approaches, medications are often an important component of treatment. Medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines can be prescribed by health care professionals to help alleviate the symptoms of anxiety. These work by balancing neurotransmitters in the brain, contributing to improved mood and reduced stress.
Lifestyle habits are equally significant in managing anxiety. Regular physical activity not only reduces anxiety symptoms but also enhances cardiovascular fitness. Adequate, restorative sleep is vital for emotional regulation and effective stress management. Incorporating stress management techniques into daily routines can further assist in maintaining a balanced emotional state.
Overall, the management of anxiety and panic disorders is multifaceted, often involving a combination of therapy, medication, and lifestyle changes to achieve the best outcomes.
Individuals can proactively protect their hearts by addressing anxiety and panic disorders. Seeking professional help and adopting healthy lifestyle practices are vital to managing anxiety disorders and supporting overall cardiovascular well-being. Recognizing the interplay between mental and physical health and prioritizing both aspects for a balanced and thriving life is essential.
Excerpted with permission from Harper Non-Fiction, an imprint of HarperCollins Publishers.
