Dieter Kleiber

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception

OBJECTIVES This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction. STUDY DESIGN AND SETTING Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria. RESULTS The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations. CONCLUSIONS The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.

Mental health of Turkish women in Germany: resilience and risk factors

BACKGROUND The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany. METHOD 105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations. RESULTS In all subjects, social strain (Pearsons r=.26(**), p=.008) and neuroticism (r=.34(**), p<.001) were positively associated with mental distress. In contrast, perceived self-efficacy (r=-.38(**), p<.001) and extraversion (r=-.36(**), p<.001) were negatively associated with mental distress. CONCLUSION Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.

The Parent Version of the Preschool Social Skills Rating System: Psychometric Analysis and Adaptation with a German Preschool Sample

The Social Skills Rating System (SSRS) developed by Gresham and Elliott (1990) is a multirater, norm-referenced instrument measuring social skills and adaptive behavior in preschool children. The aims of the present study were (a) to test the factorial structure of the Parent Form of the SSRS for the first time with a German preschool sample (391 children) and (b) to present a modified version appropriate for 3- to 6-year-olds in German preschools. The sample consisted of 391 children (187 males, 204 females) from German preschools and their parents. Confirmatory factor analyses (CFAs) revealed a poor overall fit testing the original version. For the extended age range (3-6 years) a revised version of the SSRS with a reduced and newly composed item pool is proposed based on explorative factor analyses. Results are discussed with respect to practicability and revision of SSRS for German preschool populations.

Contagiousness under antiretroviral therapy and stigmatization toward people with HIV

Perceived contagiousness is a major dimension underlying HIV-related stigmatization. Antiretroviral therapy (ART) can diminish contagiousness by reducing viral load levels in HIV-infected individuals. To test the assumption that reductions in contagiousness can lead to a decrease in stigmatizing reactions, we conducted an experimental online study. A sample of 752 participants (50.9% female) read a short vignette depicting an HIV-positive individual with either a high or a low viral load and were either given or not given information about the association between viral load and contagiousness. Subsequently, participants were asked to rate their willingness to stigmatize this individual by responding to two measures of social and physical distance. Differences between the low and the high viral load information groups and the combined no-information groups (forming a quasi-control group) were analyzed using analysis of covariance (ANCOVA), controlling for gender and baseline perceptions of contagiousness. The covariates, perceived contagiousness at baseline and gender, were associated with social and physical distancing, but the viral load/information factor was only significant in physical distancing. Planned contrast analyses confirmed that physical distancing in the informed group was lower in the low viral load condition compared to the high viral load condition and to the control group. We thus found evidence for the significant role of perceived contagiousness in the HIV-related stigma and were able to experimentally demonstrate the potential of ART to reduce HIV-related stigmatization by lowering viral load and contagiousness, when these changes are accompanied by a decreased perception of contagiousness.

The Role of Job Demands and Job Resources in the Development of Emotional Exhaustion, Depression, and Anxiety Among Police Officers:

The aim of this study was to examine whether job demands and job resources predict depression and anxiety levels among police officers and whether emotional exhaustion plays a mediating role in this relationship. In addition, we tested whether job resources can serve as a protective factor against job-related strain. A total of 843 German police officers completed the questionnaires in an online survey. Results showed that job demands (high workload and assaults by citizens) predicted higher levels of depression and anxiety among police officers, mediated through emotional exhaustion. Furthermore, job resources (social support by colleagues, shared values, and positive leadership climate) buffered the effect of job demands on emotional exhaustion and were negatively associated with depression and anxiety levels. The identification of job demands and job resources that are related to psychological strain among police officers provides important information for interventions in order to promote mental health in the context of police work.

Leadership climate prevents emotional exhaustion in German police officers

Police officers are exposed to a high amount of work effort in their everyday employment. This increases their risk of developing emotional exhaustion, the key symptom of the burnout syndrome. Previous research suggests that leadership climate is important for employees’ health and thus might be protective against emotional exhaustion. This study investigated whether a positive leadership climate prevents emotional exhaustion and buffers the negative impact of work effort in police officers. Data from a cross-sectional health survey in a German police department (N = 570) were used to test the assumptions. Results of the hierarchical linear regression analysis showed that high work effort was correlated with high levels of emotional exhaustion and positive leadership climate was associated with low levels of emotional exhaustion. Furthermore, both predictor variables interacted, indicating a buffer effect of a positive leadership climate under stressful working conditions. This is the first study to show both direct and indirect protective effects of a positive leadership climate in police officers. In police work, stressful working conditions such as high work effort are hard to avoid. Thus, it is crucial to promote preventive factors such as a positive leadership climate to protect police officers’ health. Suggestions of how police supervisors and departments might establish a positive leadership climate are presented.

Gesundheit und Bildung

Menschen mit geringem Bildungsstatus sind wahrscheinlicher von Krankheiten betroffen als Menschen mit hohem Bildungsabschluss. Dieser Zusammenhang ist darauf zuruckzufuhren, dass die Chancen auf gesellschaftliche Teilhabe und die Verfugbarkeit gesundheitsbezogener Ressourcen mit der Qualitat des Bildungsabschlusses sinken. Um diesen Kreislauf zu durchbrechen, sollten in formellen und informellen Bildungskontexten Lernprozesse angeregt werden, durch die Wissen uber Gesundheit, ein kompetenter Umgang mit Stressoren, die personliche Eingebundenheit in positive Sozialbeziehungen sowie gesundheitsrelevante Verhaltensgewohnheiten und Einstellungen gefordert werden.

Organisationsklima und Gesundheit

ZusammenfassungHintergrundAls Einflussfaktor auf die (psychosoziale) Gesundheit von Einsatzkräften im Rettungsdienst wurde das Organisationsklima bisher selten betrachtet. Dabei wird der übereinstimmende Anteil der Wahrnehmung von Organisationsmerkmalen durch die Mitarbeiter untersucht. Zwischen einzelnen Dienststellen können Ähnlichkeiten und Unterschiede im Organisationsklima auffallen, die eine Gruppierung in Dienststellen mit ähnlichem Organisationsklima zulassen. Ausgehend von Unterschieden bei bestimmten Organisationsklimamerkmalen zwischen den Gruppen von Dienststellen werden Handlungsebenen einer gesundheitsfördernden Organisationsentwicklung erkennbar, wenn sich die Gruppen zugleich beim Gesundheitszustand ihrer Mitglieder unterscheiden.MethodeBei einer Stichprobe von 316 Einsatzkräften im Rettungsdienst aus 21 Dienststellen, die im Rahmen einer bundesweiten Untersuchung im Bevölkerungsschutz befragt wurden, werden diese Annahmen untersucht.ErgebnisseDie in einem clusteranalytischen Vorgehen gebildeten Gruppen von Dienststellen unterscheiden sich in der Wahrnehmung von quantitativen Arbeitsbelastungen, Handlungsspielräumen, erlebter Gratifikation und Fairness, beim Führungsverhaltens und der Verlässlichkeit des Informationsaustauschs (Kommunikationskultur).SchlussfolgerungBei einer ausgewogenen Konstellation dieser Organisationsklimamerkmale sind Einsatzkräfte weniger erschöpft und fühlen sich stärker mit ihrer Organisation verbunden, so dass hier Handlungsebenen zur gesundheitsfördernden Organisationsentwicklung im Rettungsdienst erkennbar werden.AbstractBackgroundLittle research has been done on the importance of organizational climate for psychosocial subjective health in ambulance service organizations. Organizational climate research focuses on the pattern of organizational environment perceived by members of organizations. Similarities and differences of organizational climate between departments allow the grouping of departments with similar organizational climate. Based on differences in specific organizational climate characteristics between the groups of departments, levels of intervention for implementing/improving healthy organizations can identified, if groups also differ in employees’ health status.MethodsA sample of 316 ambulance service personnel from 21 departments was surveyed. Departments could be devided into groups with similar organizational climate by clusteranalysis.ResultsThe groups of departments are differing concerning perception of control, experienced workload, fairness, leadership behaviour and the reliability of information.ConclusionThe perception of balanced job-demands and resources are associated with less exhaustion and more commitment. The further development of participation and feedback systems, a transparent and fair allocation, and a selective extension of areas of control are suggested as levels of intervention to promote healthy ambulance service organizations.

Gesundheitsförderung an Hochschulen

Gesundheitsforderung im Setting Hochschule gehort zu den jungeren Projektinitiativen des europaischen Regionalburos der Weltgesundheitsorganisation in Kopenhagen. Als erste Universitat stellte sich die University of Central Lancashire (1995) dieser Herausforderung und konzipierte ein Rahmenprogramm fur Gesundheitsforderung, dass Interventionen in vielen Hochschulbereichen beinhaltete und derzeit als „model of good practice” europaweit Anerkennung geniest. In der Bundesrepublik Deutschland wurde zeitgleich der Arbeitskreis „Gesundheitsfordernde Hochschulen” konstituiert, in dem derzeit Vertreter gesundheitsforderungsinteressierter Hochschulen mitarbeiten. Die Palette gesundheitsforderlicher Vorhaben und Projekte an bundesdeutschen Hochschulen reicht derzeit von Einzelaktivitaten wie z.B. dem Modell praventiver Studienberatung in Dresden [1] bis zur Etablierung von Gesundheitsforderung als integriertem strukturellen Merkmal an Hochschulen wie in dem an der Universitat Bielefeld realisierten Ansatz „Per-sonalentwicklung als Mittel der Gesundheitsforderung“ [2]. Abgesehen von diesen Projekten befinden sich die ersten Hochschulen bei der Erstellung von Gesundheitsberichten fur Mitarbeiter bzw. Studenten einer Hochschule, um datengestutzt Veranderungspotenziale zu ermitteln und in Gesundheitsprojekten umzusetzen. Ziel dieses Beitrags ist es, den aktuellen Stand dieser Initiativen kritisch zu beleuchten.

Die Bewältigung der HIV-Infektion bei i.v. Drogenabhängigen. Bedürfnisse der Betroffenen, psychosoziale Hilfen und Forschungsbedarf

In der Bundesrepublik und West-Berlin leben schatzungsweise 80.000 bis 100.000 Drogenabhangige. Von diesen sind nach eigenen epidemiologischen Studien durchschnittlich 20% HIV-infiziert. Der Anteil der Drogenabhangigen unter den HIV-Infizierten nimmt seit Auftreten von AIDS kontinuierlich zu. Daher kommt der Suche nach angemessenen psychosozialen Hilfsangeboten fur die Betroffenen eine zunehmende Bedeutung zu. Bislang fehlen jedoch Untersuchungen zur Bewaltigung der Information uber den eigenen HIV-Status bzw. zur Adaptation an die HIV-Infektion, die es erlauben, langfristige Aussagen uber den Prozes der Bewaltigung bzw. uber Betreuungsbedarf zu machen.