Beate Muschalla

Workplace phobia – A first explorative study on its relation to established anxiety disorders, sick leave, and work-directed treatment

Workplace phobia is defined as a phobic anxiety reaction with symptoms of panic occurring when thinking of or approaching the workplace. People suffering from workplace phobia regularly avoid confrontation with the workplace and are often on sick leave. The specific characteristics of workplace phobia are investigated empirically in comparison to established anxiety disorders. Two hundred thirty patients from an inpatient psychosomatic rehabilitation hospital were interviewed concerning workplace phobia and established anxiety disorders. Additionally, the patients filled in self-rating questionnaires on general and workplace phobic symptom load. Subjectively perceived degree of work load, sick leave, and therapy participation were assessed. Participants with workplace phobia reached significantly higher scores in workplace phobia self-rating than did participants with established anxiety disorders. A similar significant difference was not found concerning the general psychosomatic symptom load. Workplace phobics were more often on sick leave than patients with established anxiety disorders. Workplace phobia can occur as an alonestanding anxiety disorder. It has an own clinical value due to its specific consequences for work participation. Workplace phobia requires special therapeutic attention and treatment instead of purely ‘sick leave’ certification.

Relationship between work-related attitudes, performance and capacities according to the ICF in patients with mental disorders.

Background: The International Classification of Functioning Disability and Health (ICF) differentiates between functions, activities/capacities, contextual factors and participation. Dysfunctions can result in impaired capacities, which in turn can lead to problems with participation depending on the context. Motivational and volitional deficits are intervening factors. The question is to what degree work performance (i.e. participation), motivational factors, and the inability to perform activities (i.e. dysfunctions) interact. Method: Incapacities were measured in 213 patients (70% women) admitted to the Department of Behavioral Medicine using the Mini-ICF-Rating for Mental Disorders (Mini-ICF-APP), work performance was measured with the Endicott Work Productivity Scale (EWPS), and volitional and motivational problems in regard to work were assessed with the Arbeitsbezogenes Verhaltens- und Erlebensmuster (AVEM). Sick leave prior to admission and work-related problems were assessed in a special clinical interview. Results: The mean global score of the Mini-ICF-APP across all patients was 0.84 ± 0.56 (SD), corresponding to ‘mild disability’. The highest disabilities in this patient population were found for ‘flexibility’ (item 3, 1.64 ± 0.94); the lowest disabilities were found for ‘self maintenance’ (item 11, 0.19 ± 0.44) and ‘mobility’ (item 12, 0.43 ± 0.85). Partial correlations between the Mini-ICF-APP, AVEM and EWPS showed highly significant correlations between the Mini-ICF-APP and EWPS and no or weak correlations between the AVEM and the Mini-ICF-APP or EWPS. Conclusion: Work performance is primarily related to the inability to perform activities and incapacities, and only due to attitudes or volitional/motivational factors to a much lesser degree. Therefore, capacity and motivation can and must be separated.

Die Job-Angst-Skala (JAS). Ein Fragebogen zur Erfassung arbeitsplatzbezogener Ängste

Die „Job-Angst-Skala (JAS)“ ist ein neuer Fragebogen zur Erfassung und klinischen Differenzierung verschiedener Formen arbeitsplatzbezogener Angste. Die Skala besteht aus 70 Items mit 14 Subskalen, die in funf Hauptdimensionen zusammengefasst werden konnen: Stimulusbezogene Angste und Vermeidungsverhalten; Soziale Angste und Beeintrachtigungskognitionen; Gesundheits- und korperbezogene Angste; Insuffizienzerleben; Arbeitsplatzbezogene generalisierte Sorgen. Eine Untersuchung der psychometrischen Qualitat erfolgte an 190 Patienten einer orthopadischen und psychosomatischen Rehabilitationsklinik. Die interne Konsistenz (Cronbachs alpha) betragt .98. Die Retestreliabilitat der Gesamtskala betragt .815. Faktorenanalytisch ergeben sich funf inhaltlich interpretierbare Dimensionen entsprechend der zugrunde liegenden Theorie. Die durchschnittliche Inter-Item-Korrelation der Gesamtskala betragt .389. Es fand sich ein signifikanter Zusammenhang zwischen der JAS und dem generelle Angstlichkeit messenden STAI-Trait,...

Reduction of sickness absence by an occupational health care management program focusing on self-efficacy and self-management.

BACKGROUND The aim of occupational health care management programs (OHMP) is to improve the health status of employees, increase work ability and reduce absence time. This includes better coping abilities, work-related self-efficacy and self-management which are important abilities that should be trained within OHMPs. OBJECTIVES To study the effectiveness of an OHMP including special interventions to enhance self-efficacy and self-management. PARTICIPANTS Employees from the German Federal Pension Agency. METHODS Effects of an OHMP on sickness absence was studied by comparing an intervention group and two control groups. A core feature of the OHMP were group sessions with all members of working teams, focussing on self-efficacy and self management of the individual participant as well as the team as a group (focus groups). Participants in the OHMP were asked for their subjective evaluation of the focus groups. Rates of sickness absence were taken from the routine data of the employer. RESULTS Participants of the OHMP indicated that they had learned better ways of coping and communication and that they had generated intentions to make changes in their working situation. The rate of sickness absence in the intervention group decreased from 9.26% in the year before the OHMP to 7.93% in the year after the program, while there was in the same time anincrease of 7.9% and 10.7% in the two control groups. CONCLUSIONS The data suggest that OHMP with focus on self-efficacy and self management of individuals and teams are helpful in reducing work absenteeism.

Standardized diagnostic interviews, criteria, and algorithms for mental disorders: garbage in, garbage out

There is a general consensus that diagnoses for mental disorders should be based on criteria and algorithms as given in ICD or DSM. Standardized clinical interviews are recommended as diagnostic methods. In ICD and DSM, much emphasis is put on algorithms, while the underlying criteria get much less attention. The question is how valid are the criteria that are collected by structured diagnostic interviews. 209 patients from a cardiology inpatient unit were interviewed with the Mini International Neuropsychiatric Interview (MINI). 32 (15.3%) were diagnosed as suffering from a major depressive episode or dysthymia. Additionally, a thorough clinical examination was done by a psychiatric expert in 15 patients. The standardized diagnosis of present major depression was reaffirmed in one. In total, four patients were suffering from some kind of depressive disorder presently or life time. Two patients were suffering from anxiety disorders, two from adjustment disorders, and four from different types of organic brain disorders. Most important, there are 3 out of 15 who are not mentally ill. Our observations show that standardized diagnostic interviews cannot be used to make specific differential diagnoses, but rather catch unspecific syndromes. This is partly due to the fact that the wording, definition, and understanding of the underlying criteria is rather vague. This is an even greater problem if there is any somatic comorbidity. In the revision of ICD and DSM, a glossary of psychopathological terms and guidelines for the training of clinicians should be included.

Specific Job Anxiety in Comparison to General Psychosomatic Symptoms at Admission, Discharge and Six Months after Psychosomatic Inpatient Treatment

Objective: Job anxiety is a severe problem in many patients with chronic mental disorders, as it usually results in specific participation problems in the workplace and long-term sick leave. The aim of this study was to explore the development of sick leave in dependence on general psychosomatic complaints and job anxiety from admission to a psychosomatic inpatient treatment until 6 months after discharge. Method: A convenience sample of 91 patients, suffering from multiple mental disorders, filled in self-rating questionnaires on job anxiety (Job Anxiety Scale) and on general psychosomatic symptom load (Symptom Checklist-90-Revised) at the beginning, the end, and 6 months after discharge from an inpatient psychosomatic treatment. Additionally, sick leave status and employment status were assessed before and 6 months after the treatment. Results: 15.4% of 91 patients were on sick leave before inpatient treatment and at follow-up (SS group), 20.9% were fit for work at intake and follow-up (FF group), 6.6% were fit for work initially and on sick leave later (FS group), and 57.1% on sick leave first and working at follow-up (SF group). In regard to general psychosomatic complaints, there were initially high scores on the SCL, a marked reduction during inpatient treatment, and a bouncing back to initial levels at follow-up for all 4 patient groups. SS and FS patients showed the highest scores at intake and follow-up. Concerning job anxiety, SS patients had the highest scores at all three assessments, while FF patients had significantly lower scores, with only low variation between assessments. SF patients started with comparatively high scores of job anxiety, which even increased before reentering work, but decreased in the follow-up period when they were confronted with work again. FS patients started low (like the FF patients) at intake, reduced their job anxiety further till discharge, but increased to higher scores at follow-up. Conclusions: General psychosomatic symptom load and job anxiety show a different course during treatment and are differently related to sick leave. General psychosomatic symptom load can be understood as a measure of the degree of the chronic illness status, whereas job anxiety reflects specific additional context-related problems, i.e. problems with work. A core finding is that job anxiety is related to work avoidance, but work exposure may reduce job anxiety. This has direct consequences for putting patients on sick leave or not.

Workplace Phobia, Workplace Problems, and Work Ability among Primary Care Patients with Chronic Mental Disorders

Purpose: Work-related anxieties are frequent and have a negative effect on the occupational performance of patients and absence due to sickness. Most important is workplace phobia, that is, panic when approaching or even thinking of the workplace. This study is the first to estimate the prevalence of workplace phobia among primary care patients suffering from chronic mental disorders and to describe which illness-related or workplace-specific context factors are associated with workplace phobia. Methods: A convenience sample of 288 primary care patients with chronic mental disorders (70% women) seen by 40 primary care clinicians in Germany were assessed using a standardized diagnostic interview about mental disorders and workplace problems. Workplace phobia was assessed by the Workplace Phobia Scale and a structured Diagnostic and Statical Manual of Mental Disorders–based diagnostic interview. In addition, capacity and participation restrictions, illness severity, and sick leave were assessed. Results: Workplace phobia was found in 10% of patients with chronic mental disorders, that is, approximately about 3% of all general practice patients. Patients with workplace phobia had longer durations of sick leave than patients without workplace phobia and were impaired to a higher degree in work-relevant capacities. They also had a higher degree of restrictions in participation in other areas of life. Conclusions: Workplace phobia seems to be a frequent problem in primary care. It may behoove primary care clinicians to consider workplace-related anxiety, including phobia, particularly when patients ask for a work excuse for nonspecific somatic complaints.

Different workplace-related strains and different workplace-related anxieties in different professions.

Objective: Similar to the spectrum of the traditional anxiety disorders, there are also different types of workplace-related anxieties. The question is whether in different professional settings different facets of workplace-related anxieties are predominant. Methods: A convenience sample of 224 inpatients (71% women) from a department of psychosomatic medicine was investigated. They were assessed with a structured diagnostic interview concerning anxiety disorders and specific workplace-related anxieties. Results: Office workers suffer relatively most often from specific social anxiety, insufficiency, and workplace phobia. Service workers suffer predominantly from unspecific social anxiety. Health care workers are characterized by insufficiency, adjustment disorders, posttraumatic stress disorder, and workplace phobia. Persons in production and education are least often affected by workplace-related anxieties. Conclusions: Different types of anxiety are seen in different professional domains, parallel to workplace characteristics.

Participation restrictions at work indicate participation restrictions in other domains of life

Health problems are often associated with activity limitations and participation restrictions, as defined in the International Classification of Functioning, Disability and Health (ICF). This often affects the workplace in the form of sick leave or a reduction in productivity. The question is, “to what extent are participation restrictions at work related to participation restrictions in other domains of life?” A total of 382 primary health care patients (aged 18–65) were asked to provide information on their employment status, perceived health-related workplace problems and sick leave status. Health-dependent participation restrictions across different domains of life were assessed using the Index for Measuring Participation Restrictions (IMET) self rating questionnaire. Currently unemployed patients reported significantly higher degrees of participation restrictions across all domains of life than the employed participants. Employed patients with workplace problems scored higher than patients without workplace problems. The domain of work encompassed the highest level of impairment, while the lowest was observed in personal relationships. Workplace problems occur frequently for primary health care patients. They coincide with participation restrictions in other domains of life. For patients who complain about their capacity to work, diagnosis and treatment must not only focus on the work domain, but also enquire into and consider participation restrictions in other domains of life.

Embitterment and the workplace

The workplace is an area in life where people spend much, if not most, of their time. It is important in terms of making a living, but also for the self-definition of individuals. It is characterized by rules that must be respected and requirements that must be fulfilled and by the fact that employees have to integrate within complex social relations. While the workplace provides many rewards and positive experiences, it can also be the source of severe burdens, disappointments, conflicts, or even life-threatening experiences. Workplaces evince certain features which are unavoidably associated with stress, features which are also universal and almost constituting characteristics of workplaces as such. Examples of these are desires to achieve, hierarchies and sanctions, rivalries and bullying, group interactions and conflicts, aggression on the part of customers or other third parties, job insecurity and economic or status problems.