Clinical and screening utility of the Burnout Assessment Tool: A comparative evaluation of BAT23, BAT12 and BAT4 in Sweden

OBJECTIVES: Clinical burnout may have serious personal and societal impacts, such as reduced productivity, prolonged sick leave and long rehabilitation. Regular screening using clinically relevant cut-offs to identify individuals at risk is essential for effective prevention. This study aimed to: (i) establish Swedish clinical cut-off scores for the Burnout Assessment Tool (BAT) versions (ie., BAT23, BAT12, BAT4); (ii) assess the BAT4’s ability to classify burnout severity; and (iii) calculate burnout complaints in the Swedish workforce. METHODS: A national representative sample of the Swedish working population (N=1603) and a burned-out group (N=159) diagnosed with exhaustion disorder (ED) were surveyed using BAT23, BAT12, and BAT4. Receiver operating characteristic (ROC) analyses determined diagnostic accuracy and cut-offs for mild (orange) and severe (red) burnout complaints. A sensitivity analysis using clinician-confirmed ED patients (N=25) validated findings. RESULTS: BAT23 showed the highest accuracy in differentiating between mild and severe complaints. Among the subscales, exhaustion performed best. BAT12 showed good accuracy at the orange and slightly reduced sensitivity at the red cut-off. BAT4, while showing excellent sensitivity (0.93) at the orange cut-off, had poor sensitivity (0.47) at the red cut-off, limiting its clinical utility. Prevalence estimates using Swedish cut-offs showed approximately 13% of the workforce had severe burnout complaints (BAT23 and BAT12). CONCLUSIONS: BAT23 is recommended for comprehensive assessments; BAT12 is useful for workplace screening where a shorter questionnaire is required and BAT4 for broad organizational screening using only the orange cut-off. Findings support the structured application of BAT across varying settings and a deeper understanding of the BAT4.