Association between Personal Burnout and Depression after First Stroke of Working-age patients in Thailand: A one-year follow-up study


  • Siripan Naknoi Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Email:
  • Pongrama Ramasoota Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Email:
  • Suparat Phuanukoonnon Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Email:
  • Ngamphol Soonthornworasiri 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Email:
  • Orawan Kaewboonchoo Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, Thailand. Email:


Personal burnout, Depression, First stroke, Working-age patients, Thailand


Background: Personal burnout is characterized by physical, emotional, and mental exhaustion due to prolonged stress or excessive demands. Individuals recovering from a stroke often experience significant physical and cognitive challenges during their recovery process, which can lead to increased fatigue and emotional strain. This physical and emotional exhaustion can contribute to the development or worsening of depressive symptoms.

Objective: To investigate the relationship between personal burnout at baseline and depressive symptoms after stroke over one-year

Methods: The study enrolled 103 participants who experienced their first stroke during working-age patients. The study period was 12 months. Personal burnout was assessed using the Copenhagen Burnout Inventory (CBI) at baseline, while depressive symptoms were measured using the Thai Hospital Anxiety and Depression Scale (HADS) at baseline, six months, and 12 months during the follow-up period. The study employed Generalized Estimating Equations to

investigate the longitudinal relationship between personal burnout at baseline and depression over the course of one year.

Results: High personal burnout showed a significant association with depression scores over a 1-year period, (coefficient 3.257; 95% CI: 2.299, 4.215).

Conclusions: The high personal burnout score predicted worsen depressive symptoms after stoke onset. These results suggest that healthcare workers, families, and co-workers should prioritize mental health support and early detection of depressive symptoms, treatment, and coping strategies among working-age individuals who have experienced a stroke.


Badwaik DG, Badwaik P. Influence of Psychological Disorders on the Functional Outcomes in the Survivors of Ischemic Stroke. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. 2021; 30(2): 105486. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105486

Wu QE, Zhou AM, Han YP, Liu YM, Yang Y, Wang XM, et al. Poststroke depression and risk of recurrent stroke: A meta-analysis of prospective studies. Medicine (Baltimore). 2019; 98(42): e17235. DOI: 10.1097/md.0000000000017235

Guo J, Wang J, Sun W, Liu X. The advances of post-stroke depression: 2021 update. J Neurol. 2022; 269(3): 1236-49. DOI: 10.1007/s00415-021-10597-4

Ignacio KHD, Diestro JDB, Medrano JMM, Salabi SKU, Logronio AJ, Factor SJV, et al. Depression and Anxiety after Stroke in Young Adult Filipinos. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2022; 31(2): 106232. DOI: 10.1016/j.jstrokecerebrovasdis.2021.106232

Mayer SE, Lopez-Duran NL, Sen S, Abelson JL. Chronic stress, hair cortisol and depression: A prospective and longitudinal study of medical internship. Psychoneuroendocrinology. 2018; 92: 57-65. DOI: 10.1016/j.psyneuen.2018.03.020

Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, Jorge RE, Kissela BM, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017; 48(2): e30-e43. DOI: 10.1161/str.0000000000000113

Sharma GS, Gupta A, Khanna M, Prakash NB. Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation. J Neurosci Rural Pract. 2021; 12(3): 543-9. DOI: 10.1055/s-0041-1731958

Shi YZ, Xiang YT, Yang Y, Zhang N, Wang S, Ungvari GS, et al. Depression after minor stroke: the association with disability and quality of life--a 1-year follow-up study. Int J Geriatr Psychiatry. 2016; 31(4): 421-7. DOI: 10.1002/gps.4353

Boutros CF, Khazaal W, Taliani M, Said Sadier N, Salameh P, Hosseini H. One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis. Frontiers in neurology. 2022; 13: 973200. DOI: 10.3389/fneur.2022.973200

George MG. Risk Factors for Ischemic Stroke in Younger Adults: A Focused Update. Stroke. 2020; 51(3): 729-35. DOI: 10.1161/strokeaha.119.024156

Graber M, Baptiste L, Mohr S, Blanc-Labarre C, Dupont G, Giroud M, et al. A review of psychosocial factors and stroke: A new public health problem. Revue neurologique. 2019; 175(10): 686-92. DOI: 10.1016/j.neurol.2019.02.001

Kristensen TS, Borritz M, Villadsen E, Christensen KBJW, Stress. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. 2005; 19(3): 192-207. DOI: 10.1080/02678370500297720

Schaufeli WB, Greenglass ER. Introduction to special issue on burnout and health. Psychol Health. 2001; 16(5): 501-10. DOI: 10.1080/08870440108405523

Chambers CN, Frampton CM, Barclay M, McKee M. Burnout prevalence in New Zealand's public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ open. 2016; 6(11): e013947. DOI: 10.1136/bmjopen-2016-013947

Nunn K, Isaacs D. Burnout. J Paediatr Child Health. 2019; 55(1): 5-6. DOI: 10.1111/jpc.14331

Chen C, Meier ST. Burnout and depression in nurses: A systematic review and meta-analysis. International journal of nursing studies. 2021; 124: 104099. DOI: 10.1016/j.ijnurstu.2021.104099

Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. International journal of environmental research and public health. 2020; 17(15). DOI: 10.3390/ijerph17155514

Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: A 2020 updated review. Gen Hosp Psychiatry. 2020; 66: 70-80. DOI: 10.1016/j.genhosppsych.2020.06.011

Williams OA, Demeyere N. Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke. Neurology. 2021; 96(15): e1966-e74. DOI: 10.1212/wnl.0000000000011748

Zhang S, Cheng S, Zhang Z, Wang C, Wang A, Zhu W. Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2021; 42(4): 1463-71. DOI: 10.1007/s10072-020-04633-w

Guo Y, Logan HL, Glueck DH, Muller KE. Selecting a sample size for studies with repeated measures. BMC Med Res Methodol. 2013; 13:100. DOI: 10.1186/1471-2288-13-100

Nilchaikovit TJJPAT. Development of Thai version of hospital anxiety and depression scale in cancer patients. 1996;4: 18-30. (In Thai)

Ojagbemi A, Owolabi M, Akinyemi J, Ovbiagele B. Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability. eNeurologicalSci. 2017; 9: 14-8. DOI: 10.1016/j.ensci.2017.10.002

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatrica Scandinavica. 1983; 67(6): 361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x

Ballinger GA. Using Generalized Estimating Equations for Longitudinal Data Analysis. Organizational Research Methods. 2004; 7(2): 127-50. DOI: 10.1177/1094428104263672

Chiu LY, Stewart K, Woo C, Yatham LN, Lam RW. The relationship between burnout and depressive symptoms in patients with depressive disorders. J Affect Disord. 2015; 172: 361-6. DOI: 10.1016/j.jad.2014.10.029

Sabzi N, Khosravi Z, Kalantar-Hormozi B. Parental burnout and depression among Iranian mothers: The mediating role of Maladaptive Coping modes. Brain Behav. 2023; 13(4): e2900. DOI: 10.1002/brb3.2900

Kaduka L, Muniu E, Mbui J, Oduor Owuor C, Gakunga R, Kwasa J, et al. Disability-Adjusted Life-Years Due to Stroke in Kenya. Neuroepidemiology. 2019; 53(1-2): 48-54. DOI: 10.1159/000498970

Cumming TB, Packer M, Kramer SF, English C. The prevalence of fatigue after stroke: A systematic review and meta-analysis. International journal of stroke : official journal of the International Stroke Society. 2016; 11(9): 968-77. DOI: 10.1177/1747493016669861

Vlachos G, Ihle-Hansen H, Bruun Wyller T, Brækhus A, Mangset M, Hamre C, et al. Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments. Journal of rehabilitation medicine. 2021; 53(1): jrm00135. DOI: 10.2340/16501977-2764

Nijsse B, Spikman JM, Visser-Meily JMA, de Kort PLM, van Heugten CM. Social cognition impairments are associated with behavioural changes in the long term after stroke. PloS one. 2019; 14(3): e0213725. DOI: 10.1371/journal.pone.0213725

Liao X, Zuo L, Dong Y, Pan Y, Yan H, Meng X, et al. Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study. BMC Geriatr. 2022; 22(1): 1009. DOI: 10.1186/s12877-022-03609-z

He SC, Zhang YY, Zhan JY, Wang C, Du XD, Yin GZ, et al. Burnout and cognitive impairment: Associated with serum BDNF in a Chinese Han population. Psychoneuroendocrinology. 2017; 77: 236-43. DOI: 10.1016/j.psyneuen.2017.01.002

Koutsimani P, Montgomery A, Masoura E, Panagopoulou E. Burnout and Cognitive Performance. International journal of environmental research and public health. 2021; 18(4). DOI: 10.3390/ijerph18042145

Vasile C. Mental health and immunity (Review). Exp Ther Med. 2020;20(6): 211. DOI: 10.3892/etm.2020.9341

Roland VON Känel, Raphael Manfred Herr, Vianen AEMV, BS. Association of adaptive and maladaptive narcissism with personal burnout: findings from a cross-sectional study. Ind Health. 2017; 55(3): 233-42. DOI: 10.2486/indhealth.2016-0136

Oyewole OO, Ogunlana MO, Gbiri CAO, Oritogun KS, Osalusi BS. Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity. Neurological research. 2020; 42(10): 835-43. DOI: 10.1080/01616412.2020.1785744

Chung ML, Bakas T, Plue LD, Williams LS. Effects of Self-esteem, Optimism, and Perceived Control on Depressive Symptoms in Stroke Survivor-Spouse Dyads. J Cardiovasc Nurs. 2016; 31(2): E8-e16. DOI: 10.1097/jcn.0000000000000232

French MA, Miller A, Pohlig RT, Reisman DS. Depressive Symptoms Moderate the Relationship Among Physical Capacity, Balance Self-Efficacy, and Participation in People After Stroke. Phys Ther. 2021; 101(12). DOI: 10.1093/ptj/pzab224

Vitturi BK, Mitre LP, Kim AIH, Gagliardi RJ. Prevalence and Predictors of Fatigue and Neuropsychiatric Symptoms in Patients with Minor Ischemic Stroke. J Stroke Cerebrovasc Dis. 2021; 30(9):105964. DOI: 10.1016/j.jstrokecerebrovasdis.2021.105964.

Almeida OP. Stroke, depression, and self-harm in later life. Curr Opin Psychiatry. 2023; 36(5): 371-5. DOI: 10.1097/yco.0000000000000882.

Morsund Å H, Ellekjaer H, Gramstad A, Reiestad MT, Midgard R, Sando SB, et al. The development of cognitive and emotional impairment after a minor stroke: A longitudinal study. Acta Neurol Scand. 2019; 140(4): 281-9. DOI: 10.1111/ane.13143.