1,721,037 research outputs found
Workplace Phobic Anxiety as a Mental Health Phenomenon in the Job Demands-Resources Model
Get PDFPurpose. Anxiety-related problems at work are a serious problem in the occupational context, as they come along with sick leave and problems in work participation. The aim of this study is to analyse workplace phobic anxiety in nonclinical context using the Job Demands-Resources model. Methods. The study involved a sample of 739 workers from a retail company, mostly with permanent contracts. Structural equation modelling analyses were performed using AMOS software. Results. Both the health impairment and motivational variables in the JD-R model were significantly related to workplace phobic anxiety and subsequently to absenteeism, specifically, exhaustion mediated between perceived job demands and workplace phobic anxiety and work engagement mediated between perceived job resources and workplace phobic anxiety. Moreover, workplace phobic anxiety was significantly positively related to absenteeism. Conclusions. Results suggest that workplace phobic anxiety is a specific concept and an important issue in organizations for both workers’ health and the organizational costs linked to absenteeism. Supervisors and occupational physicians should be aware of workplace phobic anxiety, especially when workers are on sick leave often or for long periods.</jats:p
Cancer-specific distress in spouses of cancer patients
Get PDFEine Tumorerkrankung erzeugt Distress für das gesamte Familiensystem des Betroffenen. Partner*innen von Erkrankten bilden dabei den primären, nicht professionellen Unterstützer. Allerdings ist auch der/die Partner*in einer Vielzahl von psychischen, sozialen und organisatorischen Belastungen ausgesetzt. Die Psychoonkologie nimmt daher den/die Partner*in verstärkt mit in den Fokus von Forschung und Behandlung. Zur Erfassung von krebsspezifischem Distress bei Partner*innen von Krebserkrankten ist bis dato kein psychometrisch geprüftes Messinstrument vorhanden. Der Fragebogen zur Belastung von Partner*innen von Krebserkrankten (FBK-P) wurde in einer Vorstudie an einer kleinen Stichprobe erstmalig pilotiert. Diese Arbeit validiert den FBK-P an einer großen Stichprobe (N = 305) von Partner*innen krebserkrankter Patient*innen. Die Faktorenstruktur des Fragebogens konnte repliziert werden und die Inhalts-, Reliabilitäts- und Validitätsanalysen ergaben gute bis sehr gute Kennwerte. Eine neu entwickelte Kurzform des FBK-P weist ebenfalls zufriedenstellende Ergebnisse auf. Für beide Varianten des Fragebogens wurden mit Hilfe von ROC-Analysen Cut-Offs definiert. Mithilfe des FBK-P wurden Prädiktoren für die Entstehung von krebsspezifischem Distress bei Partner*innen ermittelt. Hier lieferten das Alter und eigene körperliche Erkrankungen von Partner*innen und das Erkrankungsstadium von Patient*innen signifikante Ergebnisse. Um das Konstrukt Distress bei Partner*innen von Krebserkrankten differenziert zu erfassen, wurde zudem eine qualitative Befragung dieser ausgewertet und kategorisiert. Hauptsächliche Belastungen bilden psychische und medizinische Faktoren. Unter den Ressourcen der betroffenen Partner *innen ist vor allem die soziale Unterstützung relevant. Die Ergebnisse werden unter Berücksichtigung des aktuellen psychoonkologischen Forschungsstands diskutiert. Implikationen für die wissenschaftliche Forschung und klinische Versorgung werden abgeleitet.An individual's diagnosis of cancer also leads to significant distress in the patients' families. The spouse is the primary non-professional caregiver of the patient and carries the burden of psychological, social and organisational distress. Psychooncology therefore increasingly focuses the partner in research and treatment. Thus, validated instruments for the assessment of spousal cancer-specific distress is necessary. To date, no psychometrically tested tool to asses cancer-specific distress among spouses of tumor patients is available. The questionnaire on stress in partners of cancer patients (QSC-P, german: FBK-P) has already been piloted in a preliminary study with a small sample. The aim of this paper is the validation of the QSC-P on a large sample (N = 305) to ensure the psychometric quality and to develop a screening version of the questionnaire. The three-factor structure of the instrument proved to be stable across samples. Psychometric properties of the QSC-P were satisfying and the content, reliability and validity analyses resulted in good to very good characteristic values. The newly developed short form of the QSC-P also shows satisfactory results. Cut-off scores based on ROC-analyses were defined for both versions of the questionnaire. Furthermore, predictors for the development of cancer-specific distress among partners were determined (namely, age and own physical illnesses of the spouse as well as the disease stage of the patient). In order to profoundly differentiate distress among spouses of cancer patients, a qualitative survey of partners was conducted. Psychological symptoms and medical treatment were identified as the main stressor while social support by family members and friends proved to be the main resource base. The results are discussed, taking the current state of psycho-oncological research into account. Implications for scientific research and psychosocial care are derived
Aufmerksamkeitsverzerrungen in militärischen Einsatzkräften mit posttraumatischer Belastungsstörung und deren Veränderlichkeit nach Bereitstellung einer internet-basierten kognitiv-behavioralen Intervention
Get PDFPosttraumatic stress disorder (PTSD) is a prevalent and highly disturbing mental health condition that occurs in response to extremely distressing events during the lifetime. First, military personnel represent a high-risk population for the development of posttraumatic stress symptoms (PTSS) or the full-diagnostic spectrum of the disorder due to deployment- and combat-related stressors during their military career. Despite the existence of well established
and efficacious psychotherapy treatments for PTSD, access to trauma-focused
psychotherapy is limited and veterans in particular experience high barriers to accessing help from the mental health care system. A substantial proportion of affected veterans receive no or inadequate treatment, increasing the risk of secondary adverse mental and somatic health outcomes, reduced social and occupational functioning, and of the condition becoming chronic. Second, internet-based interventions (IBI), particularly internet-based cognitive
behavioral therapies (iCBT), have been shown to be efficacious and widely accepted for the treatment of a range of psychiatric disorders, including PTSD. IBI can already be seen as playing a potentially important role in supplementing the landscape and provision of psychotherapeutic interventions, and this is set to grow further in the future. Indeed, IBI should be particularly beneficial for patients in rural areas with a restricted psychotherapy infrastructure, for patients with restricted mobility, and for patients who desire greater anonymity and more independence regarding the time and location of psychotherapy access. Third, the systematic and reliable assessment of objective indicators of symptom expression and symptom change is of increasing interest and relevance for psychotherapy research. This dissertation thesis aims at incorporating these three pillars in four studies: First, a diagnostic identification of PTSD in veterans of the German Armed Forces (GAF) according to the main diagnostic manuals the International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM); second, a meta-analytical evaluation of the efficacy of IBI in PTSD; third, an assessment of
patterns of visual attentional bias in (traumatized) veterans (with PTSS); and fourth, an exploration of the modifiability of attentional bias in veterans after receiving iCBT. STUDY 1 investigated the concordance of PTSD prevalence rates when transiting between the diagnostic criteria of the DSM-IV, DSM-5, ICD-10, and proposed ICD-11 in a sample of service members of the GAF. High levels of agreement emerged between the DSM-IV and the DSM-5, and between the DSM-5 and the proposed ICD-11. Prevalence rates were significantly higher according to the proposed ICD-11 compared to the ICD-10, mainly due to the deletion of the time criterion. STUDY 1 provides support for the identification of six ‘core’ PTSD symptoms according to the proposed ICD-11, presenting a high agreement rate with the set of twenty qualifiers according to the DSM-5. STUDY 2 provided meta-analytical evidence for the efficacy of IBI for the treatment of PTSD. Twenty randomized controlled trials (RCT) encompassing 21 comparisons were included, evaluating either iCBT or internet-based expressive writing (iEW) with passive or active control conditions. The results revealed that iCBT was more efficacious than passive control conditions at post-treatment assessment (0.66 ≤ g ≤ 0.83). No superiority of either iCBT or iEW was found in contrast to active control conditions. Subgroup analyses revealed no significant moderators of iCBT efficacy. More research is needed to prove the efficacy of IBI in contrast to active control treatments and further explore the impact of moderators on treatment efficacy. STUDY 3 measured patterns of attentional bias in GAF veterans with PTSS, traumatized veterans without PTSS, and unexposed healthy veterans. In a free-viewing task, participants were presented with pairs of combat-related and neutral pictures, of more general threat-related and neutral pictures, and of emotional and neutral faces, while their eye gazes were tracked. Further, the internal consistency of attentional bias indicators was calculated. The findings provide support for the maintenance hypothesis in PTSS. There was no robust evidence to support the hypothesis of hypervigilant behavior in PTSS. Findings on attentional bias variability remain unclear. Internal consistency varied across attentional bias indicators, highlighting the need for future research in this regard. STUDY 4 investigated the modifiability of attentional bias in veterans with PTSS through the provision of iCBT. In a free-viewing task, participants were presented with combat-related, general threat-related, and neutral pictures, and with faces with negative emotional valence and neutral facial expressions while their eye gazes were tracked.
Attentional bias was examined pre- and post-intervention and at a three-month follow-up. No modifications in attentional bias were observable over time. Future investigations are warranted to systematically investigate objective measures of symptom expression and symptom change together with subjective symptom reporting and symptom change in response to psychotherapeutic treatment options. In summary, this dissertation thesis provides a threefold contribution to the current landscape of psychotherapy research: First, it supports the concordance between the DSM-5 and the ICD-11 diagnostic criteria for PTSD. Second, it proves the efficacy of IBI for PTSD.
In view of the growing relevance of IBI as a supplement to psychotherapeutic care, future research needs to examine its long-term efficacy, whether it shows equal or superior efficacy compared to other active (control) treatments, potential side effects, and whether it may lead to a deterioration of symptoms. Moreover, studies should focus on tailoring IBI to the specific needs of different patient populations to ensure patients’ safety and satisfaction with IBI. Third, the present thesis underlines the need for systematic and reliable assessments of objective indicators of symptom presentation and of symptom change, in addition to subjective reports. Moreover, methodological approaches need to be extended to measure diverse dimensions of symptom presentation and symptom change and gain a better understanding of their interplay. A multidimensional diagnostic approach and treatment evaluation will be of key relevance for future intervention research and evidence-based practice
Diagnostik „rund um die Arbeit“ bei psychischen Erkrankungen
Get PDFEtwa 60% der Patienten in der psychosomatischen Rehabilitation kommen mit arbeitsplatzbezogenen Ängsten und Problemen. Aber auch in der ambulanten Praxis findet man unter Patienten mit chronischen psychischen Erkrankungen etwa 10%, die ihrem Arbeitsplatz mit phobischem Vermeidungsverhalten gegenüberstehen und häufig in einer Langzeitarbeitsunfähigkeit stecken (Muschalla & Linden 2013).
Herauszufinden, was bei diesen Patienten das Problem ist, ist eine unabdingbare Voraussetzung um einen passenden Behandlungsansatz zu finden
Psychological work capacity demands
Get PDFExploring psychological work demands is the basis for preventive or rehabilitative action, e.g. mental hazard analysis or work adjustment. Can descriptions from employees be useful to describe work demands? The latter requires that the work description is not confounded with an affective judgment on the workplace, e.g. work-anxiety.
Based on an ICF-based work capacity concept which is standard in socio-medical work ability description, we did a study with 124 employees from diverse professions. They were investigated concerning their work demands and their mental health status in a structured interview by a state-licensed socio-medically trained psychotherapist. Additionally, participants filled in a capacity-oriented self-rating questionnaire on their work demands. For discriminant validity purposes, participants filled in the Short Questionnaire for Work Analysis, and a questionnaire on work-anxiety.
Results show that different psychological work capacity demands are reported in different professional groups. The work capacity demands self-rating is able to differentiate capacity demands in different professional fields.Psychische Arbeitsanforderungen zu beschreiben ist eine Voraussetzung um präventive oder rehabilitative Maßnahmen in Organisationen umzusetzen, bspw. im Rahmen von betrieblichen Wiedereingliederungen oder Arbeitsplatzanpassungen. Eine wichtige Frage in diesem Kontext ist, auf welche Weise verlässliche Informationen zu Arbeitsanforderungen gewonnen werden können. Im Fall von Selbstberichten muss sichergestellt sein, dass die Arbeitsplatzbeschreibung nicht durch subjektives Befinden und arbeitsplatzbezogene Gefühle, bspw. Ängste, verzerrt wird. Die Arbeitsplatzbeschreibung soll die Tätigkeitsanforderungen beschreiben.
Basierend auf einem ICF-orientierten Fähigkeitskonzept, das in der deutschsprachigen Sozialmedizin ein etabliertes Standardkonzept im Rahmen der Arbeitsfähigkeitsbeschreibung darstellt, wurde eine Untersuchung an 124 Personen verschiedenster Berufsfelder durchgeführt. Im strukturierten Interview durch eine sozialmedizinisch erfahrene Verhaltenstherapeutin wurden der psychische Gesundheitszustand und die Arbeitsplatzbeschreibung erhoben. Darüber hinaus füllten die Probanden einen ICF-basierten Selbstbeurteilungsfragebogen zur fähigkeitsorientierten Arbeitsplatzbeschreibung aus. Zu Validierungszwecken wurde zusätzlich eine Arbeitsbeschreibung mit dem Kurzfragebogen zur Arbeitsanalyse (KFZA) erhoben, sowie die Arbeitsangst. Im Ergebnis zeigt sich, dass von verschiedenen Berufsgruppen unterschiedliche Arbeitsanforderungsprofile berichtet werden. Der Selbstbeurteilungsfragebogen zur fähigkeitsorientierten Arbeitsplatzbeschreibung kann zwischen Arbeitsplatzbeschreibung und Arbeitsangst differenzieren.
Psychologische Arbeitsanforderungen können als Fähigkeitsanforderungen exploriert werden und mittels Selbstauskunftsberichten der Arbeitsplatzinhaber unterstützt werden
Work anxiety and sick leave
Get PDFBackground: Mental work-ability decisions must be based on information on person´s symptom load, cognitive performance and workplace conditions. This investigation explores in which way these factors contribute to work ability in persons with common mental disorders CMD).
Methods: 1570 CMD-patients underwent multimodal medical diagnostic. Participants filled in questionnaires on work-phobic-anxiety and general mental symptom load. They were also investigated concerning their cognitive performance. Sick leave duration, workplace problems and subjective work-ability were assessed. Physicians´ decision on the persons´ work-ability (fit or unfit for work) was given five weeks later.
Results: Negative work-ability perception, long previous sick leave duration and high work phobic anxiety explained unfitness for work, whereas general symptom load and general cognitive performance did not.
Conclusion: Work-directed diagnostics and interventions must address work-phobic anxiety and subjective work ability perception
A concept of psychological work capacity demands – first evaluation in rehabilitation patients with and without mental disorders.
Get PDFBACKGROUND: Work capacity demands are a concept to describe which psychological capacities are required in a job. Assessing psychological work capacity demands is of specific importance when mental health problems at work endanger work ability. Exploring psychological work capacity demands is the basis for mental hazard analysis or rehabilitative action, e.g. in terms of work adjustment.
OBJECTIVE: This is the first study investigating psychological work capacity demands in rehabilitation patients with and without mental disorders.
METHODS: A structured interview on psychological work capacity demands (Mini-ICF-Work; Muschalla, 2015; Linden et al., 2015) was done with 166 rehabilitation patients of working age. All interviews were done by a state-licensed socio-medically trained psychotherapist. Inter-rater-reliability was assessed by determining agreement in independent co-rating in 65 interviews. For discriminant validity purposes, participants filled in the Short Questionnaire for Work Analysis (KFZA, Prümper et al.,1994).
RESULTS: In different professional fields, different psychological work capacity demands were of importance. The Mini-ICF-Work capacity dimensions reflect different aspects than the KFZA. Patients with mental disorders were longer on sick leave and had worse work ability prognosis than patients without mental disorders, although both groups reported similar work capacity demands.
CONCLUSIONS: Psychological work demands - which are highly relevant for work ability prognosis and work adjustment processes - can be explored and differentiated in terms of psychological capacity demands
Work disability in different professions
Get PDFObjective: Up to 29% of the working population suffer from (chronic) mental disorders and work disability. As different professions pose different psychological capacity demands, one core aspect for describing work disability is psychological capacity limitations. The distribution of capacity limitations in patients with chronic mental disorders (CMD) from different professional fields is unknown, as well as their relation with sick leave.
Objective: Are there different work ability limitations in CMD patients working in different professions?
Methods: 263 CMD patients from different professions were investigated cross-sectionally in a thorough medical and psychological assessment by a trained psychosomatic study physician. Besides CMD diagnostic (MINI) and subjective work ability limitations (IMET), an observer rating on capacity limitations was conducted with Mini-ICF-APP.
Results: No relevant differences in perceived work ability limitations were found between the professions. Differences of capacity limitations were better explained by psychopathology than by profession. But capacity limitations were differently related with sick leave in different professions and there are differences in sick leave duration.
Conclusions: The variance of capacity limitations was explained by psychopathology. The variance of sick leave duration was explained by profession. Similar capacity limitations are associated differently with sick leave in different professions. Different professional fields may have different tolerances towards the same capacity limitations. Therefore, similar capacity limitations are more or less strongly associated with sick leave in different professions
Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie : Konzeptualisierung einer lebensbereichsspezifischen psychischen Erkrankung
No full textBackground: Anxiety in the workplace is a special problem as workplaces are especially prone to provoke anxiety: There are social hierarchies, rivalries between colleagues, sanctioning through superiors, danger of accidents, failure, and worries of job security. Workplace phobia is a phobic anxiety reaction with symptoms of panic occurring when thinking of or approaching the workplace, and with clear tendency of avoidance. Objectives: What characterizes workplace-related anxieties and workplace phobia as domain-specific mental disorders in contrast to conventional anxiety disorders? Method: 230 patients from an inpatient psychosomatic rehabilitation center were interviewed with the (semi-)structured Mini-Work-Anxiety-Interview and the Mini International Neuropsychiatric Interview, concerning workplace-related anxieties and conventional mental disorders. Additionally, the patients filled in the self-rating questionnaires Job-Anxiety-Scale (JAS) and the Symptom Checklist (SCL-90-R)measuring job-related and general psychosomatic symptom load. Results: Workplace-related anxieties occurred together with conventional anxiety disorders in 35% of the patients, but also alone in others (23%). Workplace phobia could be found in 17% of the interviewed, any diagnosis of workplace-related anxiety was stated in 58%. Workplace phobic patients had significantly higher scores in job-anxiety than patients without workplace phobia. Patients with workplace phobia were significantly longer on sick leave in the past 12 months (23,5 weeks) than patients without workplace phobia (13,4 weeks). Different qualities of workplace-related anxieties lead with different frequencies to work participation disorders. Conclusion: Workplace phobia cannot be described by only assessing the general level of psychosomatic symptom load and conventional mental disorders. Workplace-related anxieties and workplace phobia have an own clinical value which is mainly defined by specific workplace-related symptom load and work-participation disorders. They require special therapeutic attention and treatment instead of a “sick leave” certification by the general health physician. Workplace phobia should be named with a proper diagnosis according to ICD-10 chapter V, F 40.8: “workplace phobia”.Hintergrund: Angst am Arbeitsplatz ist ein spezielles Phänomen, da Arbeitsplätze ihrer Natur nach angstauslösende Charakteristika aufweisen: Vorgesetzte die sanktionieren, Rangkämpfe mit Kollegen, reale Unfallgefahren, Scheitern und Leistungsversagen, Unklarheit um plötzliche Veränderungen, Arbeitsplatzunsicherheit. Arbeitsplatzphobie ist eine phobische Angstreaktion mit Panikerleben beim Gedanken an oder bei Annäherung an den Arbeitsplatz. Fragestellung: Was charakterisiert arbeitsplatzbezogene Ängste und Arbeitsplatzphobie als lebensbereichsspezifische Angsterkrankungen in Abgrenzung zu klassischen Angsterkrankungen? Methode: 230 Patienten einer stationären psychosomatischen Rehabilitation wurden im halbstrukturierten Interview (Mini-Arbeits-Angst-Interview, Mini International Neuropsychiatric Interview) hinsichtlich arbeitsplatzbezogener Ängste und klassischer psychischer Erkrankungen befragt. Selbsteinschätzungsurteile wurden hinsichtlich des Schweregrads der arbeitsbezogenen (Job-Angst-Skala, JAS) und allgemeinen psychosomatischen (Symptom-Checkliste, SCL-90-R) Symptombelastung erhoben. Ergebnisse: 58% der befragten Patienten litten an mindestens einer arbeitsplatzbezogenen Angstvariante. Arbeitsplatzbezogene Ängste kamen bei 35% der Befragten zusammen mit einer klassischen Angsterkrankung vor, bei 23% jedoch als allein stehende Angsterkrankung. 17% der Befragten erfüllten die Kriterien einer Arbeitsplatzphobie. Arbeitsplatzphobie-Patienten hatten signifikant höhere Job-Angst-Werte als Patienten ohne Arbeitsplatzphobie, und sie waren signifikant länger arbeitsunfähig in den letzten 12 Monaten (23,5 Wochen versus 13,4 Wochen). Schlussfolgerung: Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie haben eine spezielle klinische Wertigkeit, die sich anhand arbeitsbezogener Partizipationsstörungen und spezifischer arbeitsbezogener Symptombelastung beschreiben lässt. Arbeitsplatzphobie erfordert besondere therapeutische Herangehensweisen anstelle von angsterhaltender da Vermeidungsverhalten fördernder „Krankschreibung“. Arbeitsplatzphobie sollte als Diagnose benannt werden entsprechend ICD-10 Kapitel V, F 40.8: “Arbeitsplatzphobie”
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