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Background The psychosocial work environment affects our health (e.g., sick leave and mortality rates). Research on psychosocial work factors and burnout has focused on specific workplaces or occupations and rarely evaluated in the general population or used longitudinal designs. In Sweden, the diagnosis of exhaustion disorder (closely related to burnout) is a common cause for sick leave. The effects of psychosocial work environments on the process of returning to work has not been studied in this specific patient group. The overall aims of this thesis were to (1) assess the level of burnout in a working general population and investigate the importance of psychosocial work factors and sex on burnout, and (2) study reduction of sick leave and experiences of returning to work in burnout patients, with special attention towards psychosocial work factors.

Methods An occupationally active subset (n=1000) of the 2004 Northern Sweden MONICA survey was used in a cross-sectional study. A five-year follow-up of this population was also performed (n=626). Level of burnout was measured using the Shirom Melamed Burnout Questionnaire (SMBQ). Burnout patients were studied for the second thesis aim. A cohort of 117 patients from the REST project was investigated using a baseline questionnaire and sick leave data at two-year follow-up. Grounded Theory was used for an in-depth interview and analysis of 12 employed patients.

Results Cross-sectional results from the working general population showed that women have higher levels of burnout than men. In both sexes, work demands, work control, and job insecurity were associated with burnout levels. Among women, education, socioeconomic position, work object, and working hours were also important. Work factors in combination with situational life factors explained about half the difference in burnout level between women and men. Longitudinal results show that burnout levels decrease with age in both sexes, although the changes occur at an earlier age for men. A constant job strain, increased job insecurity, and a worsened economic situation are related to an increase in burnout level. When studying risk factor accumulation, each additional risk factor exposure increases the burnout level.

In burnout patients, low work control and use of covert coping towards supervisors and workmates predicts unchanged sick leave levels after a twoyear period. Borderline significance was found between work overcommitment and reduced sick leave. Both personal resources and external support are described as important factors when regaining the ability to work. Perceived validation, insights into the situation and adaptive coping skills increase the chance of regaining the ability to work. External support, particularly from the workplace, is also important.

Conclusion There are links between psychosocial work factors and burnout levels in a working general population and sick leave levels in burnout patients. Socioeconomic position and working conditions are important for the level of burnout among working women. In the working population, age differences occur between the sexes; women reduce their burnout levels later in life than men. In the burnout patient population, coping patterns and control at work predict sick leave levels after two years. Both internal resources and external support are important when burnout patients describe the process of regaining the ability to work. The workplace and the work environment are important in preventing working people from becoming burned out and in easeing return to work after sick leave. A person’s coping pattern is also important in reduction of sick leave.