SINGAPORE - When Ms Le Giang, 37, started a business selling Vietnamese street food in a kopitiam here nearly two years ago, she looked forward to being her own boss.
The degree holder, who was previously a regional sales manager for a multinational firm, has since realised being her own boss is far from rosy.
"It's extremely hard running it alone," she said.
Some days, she relies on cups of coffee and cans of energy drink Red Bull to keep going. She has had to close the stall on a few occasions because she was too sick to work.
"People don't understand that it's very stressful... Some assume I am a village girl who came here to marry an old man, and demand that I serve them when I tell them it's self-service," said the Vietnamese national, who came here to attend school and is now a Singapore permanent resident.
Aside from the treatment, she is unable to find a worker to split the daily tasks with, so she toils 13 to 14 hours a day.
"The challenge is finding suitable staff. I feel my body breaking down... I don't know how long more I can take this before my health fails," she said.
"This job is sucking the life out of me... I want to quit every day. I dream of going back to the office."
She plans to sell her business if she cannot find a partner in the next few months.
Ms Le Giang is someone who may be described as being burnt out. It is a term loosely bandied about when one is having a bad day or week at work and may not always be taken seriously.
But last week, the World Health Organisation (WHO) put the spotlight on this syndrome when it recognised "burnout" in its International Classification of Diseases as an "occupational phenomenon", though not a medical condition.
Burnout, according to the WHO, is characterised by feelings of energy depletion or exhaustion, increased mental distance from one's job, feelings of negativism or cynicism related to one's job and reduced professional efficacy.
It described the syndrome as one that results from chronic workplace stress that has not been successfully managed.
There is no major study on burnout in Singapore, but that does not mean the syndrome is not common here.
Dr Lim Boon Leng, a psychiatrist at Gleneagles Medical Centre, said the lack of definitive diagnostic criteria would mean that it is difficult to conduct studies on burnout to begin with.
"Personally, I do believe that burnout is a big problem in Singapore, as we hold ourselves to high standards and are very mindful of productivity," he said.
"Also, Singapore is an extremely competitive and materialistic society. As such, we hold our jobs and job titles in high esteem and are afraid of losing our jobs."
A survey released by health service company Cigna in March this year showed that Singaporeans are among the most stressed at work globally, with almost one in eight considering their stress unmanageable.
On top of a busy work schedule, they find it hard to cope with the "always on" corporate culture.
Surveys on workplace stress done by human resource firms have also shown that many workers here are highly stressed or expect their stress levels to rise. The results indicate burnout might be common.
Among doctors specifically, a study published in late 2017 in the Singapore Medical Journal, showed that the burnout rate among junior doctors in Singapore was higher than that in the United States. They also had lower levels of empathy. Furthermore, physician burnout has been found to be an economic burden, said Assistant Professor Joel Goh from the Department of Analytics and Operations at National University of Singapore Business School.
His study on the cost of physician burnout in the US, published in the Annals of Internal Medicine journal last week, showed that in the US, physician burnout will likely cost its healthcare system approximately US$4.6 billion (S$6.3 billion) a year.
"In physicians' quest to care for patients, they often forget to care for themselves," said Prof Goh. Investing in burnout prevention and remediation is not only good and ethical managerial practice, but can also make good business sense, he said.
"Do you really want a burnt out guy taking care of you? It ultimately trickles down to the care that patients receive," said Prof Goh. "But, even if there was zero impact on patient outcome, there's something to be said about ensuring that the people who work for you are cared for. It's what good management is."
Caregiving is another area where stress is known to run high. "The demands of caregiving can be overwhelming, especially when you feel you have little control over the situation," said Dr Kinjal Doshi, the principal clinical psychologist at the Singapore General Hospital.
"Prolonged exposure to such stress will eventually lead to burnout and it takes a toll on your physical health, relationships with others and psychological well-being." If nothing is done, caregivers may start to report feelings of helplessness and have difficulty managing emotions such as sadness and anger, he said.
"For burnout per se, without other consequential psychiatric disorder, some adjustment in workload or respite from work may be all that is needed," said Dr Lim. Patients with burnout get medical leave, he said. "Ironically, many individuals would refuse to consume the medical certificates, as they are either too committed to their work or are afraid of being judged negatively by superiors and peers."
To prevent a burnout, it is important to find someone with whom you can talk about your feelings and frustrations, prioritising activities that bring you joy and meaning, and to get plenty of sleep. The fear is of the burnout becoming worse. It can manifest as physical, affective, cognitive, behavioural and motivational symptoms. It can overlap with psychiatric diagnoses like adjustment disorder, depression and anxiety disorders, said Dr Lim.
"In seeing these cases, I will consider job burnout as the triggering factor of these psychiatric conditions," he said.
Should burnout develop into depression or anxiety disorder, medication treatment or psychotherapy may be needed. "Allowing the diagnosis of burnout helps to fill the gap between work stress and overt psychiatric illnesses," said Dr Lim. "This allows burnout to be recognised and for working adults to seek help earlier without having to be diagnosed with a traditional psychiatric condition like depression, which may carry more stigma."
Nevertheless, if workplace stressors remain unchanged, burnout can recur.
According to The Great-West Life Centre for Mental Health in the Workplace in Canada, burnout is more likely when employees expect too much of themselves or feel unappreciated for their work efforts.
Prevention strategies for employers include setting reasonable and realistic expectations, making sure employees have the necessary skills to meet them, helping employees understand their value to the organisation, and assessing the workload for those who feel pressured to remain working beyond normal business hours.
To help support burnt out employees, employers can develop a plan that includes asking the employee how best to recognise their successes and victories. This could include immediate and personal praise, opportunities for growth and development, public recognition, or incentives, the centre said.