Burnout or depression — and why the screeners disagree

Patients often arrive saying 'I'm depressed', score borderline on PHQ-9 (/screeners/phq-9), and yet feel completely unrecognised by the result. That gap is usually burnout — and the MBI-short (/screeners/mbi-short) catches it.

PHQ-9 measures depressive symptom severity over two weeks across nine criteria. MBI-short measures three burnout dimensions — emotional exhaustion, cynicism toward work, and reduced personal efficacy — specifically in relation to the job. Someone can be high on MBI and low on PHQ-9; that pattern almost always points at workplace conditions, not mood pathology.

Burnout responds primarily to structural changes: workload, autonomy, recovery time, perceived fairness, and a sense of contribution. Therapy alone, without these, is a holding action. We use Cognitive Regulation in burnout to stabilise the body and protect off-hours, but the durable fix is almost always negotiated at work — and we coach the patient through that negotiation explicitly.

If both PHQ-9 and MBI-short are high, treat both lanes. Mood-first if there is any safety risk, structural-first if not. The Behavioural Activation tool (/tools/behavioural-activation) and a deliberate Sleep Wind-Down (/tools/sleep-winddown) are useful first steps either way.