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Workplace-related anxieties and workplace phobia : a concept of domain-specific mental disorders
(2008)
Background: 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”.
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.
Workplaces contain by their very nature different anxiety-provoking characteristics. When workplace-related anxieties manifest, absenteeism, long-term-sick leave, and even disability pension can be the consequences. In medical-vocational rehabilitation about 30-60 % of the patients suffer from workplace-related anxieties that are often a barrier for return to work. Even in mentally healthy employees, 5 % said that they were prone to ask for a sick leave certificate due to workplace-related anxieties. Future research should focus on workplace-related anxieties not only in rehabilitation, but more earlier, i. e. in the workplace. The concept of workplace-related anxieties offers ideas which can be useful in mental-health-oriented work analysis, employee-workplace-fit, and job design.
Work-anxieties are costly and need early intervention. The perception of being able to cope with work is a basic requirement for work ability. This randomized controlled trial investigates whether a cognitive behavioural, work-anxiety-coping group (WAG) intervention leads to better work-coping perception than an unspecific recreational group (RG). Heterogeneous people in medical rehabilitation, who were due to return to work, were interviewed concerning their work-anxieties, and either randomly assigned to a WAG (n=85) or a RG (n=95). The participants (with an average of 50years old [range 23-64]; 51% women; 70% workers or employees, 25% academics, 5% unskilled) followed the group intervention for four or six sessions. The perceived work-coping was assessed by self-rating (Inventory for Job-Coping and Return Intention JoCoRi) after each group session. Although participants had a slight temporary decrease in work-coping after group session two (from M-1=2.47 to M-2=2.28, d(Cohen)=-.22), the WAG led to the improvement of perceived work-coping over the intervention course (from M-1=2.47 to M-6=2.65, d(Cohen)=.18). In contrast, participants from the RG reported lower work-coping after six group sessions (from M-1=2.26 to M-6=2.02, d(Cohen)=-.18). It is considered that people with work-anxieties need training in work-coping. By focusing on recreation only, this may lead to deterioration of work-coping. Indeed, intervention designers should be aware of temporary deterioration (side effects) when confronting participants with work-coping.
Objective: The aim of this study was to study the effects of a short-term cognitive behavior therapy on work-anxiety and sickness-absence in patients with work-anxiety. Methods: Three-hundred forty-five inpatients who suffered from cardiologic, neurological, or orthopedic problems and additionally work-anxiety were randomly assigned into two different group interventions. Patients got four sessions of a group intervention, which either focused on cognitive behavior-therapy anxiety-management (work-anxiety coping group, WAG) or unspecific recreational activities (RG). Results: No differences were found between WAG and RG for work-anxiety and subjective work ability. When looking at patients who were suffering only from work-anxiety, and no additional mental disorder, the duration of sickness absence until 6 months follow-up was shorter in the WAG (WAG: 11 weeks, RG: 16 weeks, P = 0.050). Conclusion: A shortterm WAG may help return to work in patients with work-anxieties, as long as there is no comorbid mental disorder.
Background Job-anxiety, as distinguished from trait-anxiety, is associated with long-term sickness absence. The prevalence of job-anxiety within a working population is not known. Identifying individuals who would benefit from intervention might be useful.
Aims To investigate job-anxiety in employees not undergoing treatment for mental health illness, firstly by assessing the level of job-anxiety and work-related avoidance tendencies in a working sample, and secondly by testing whether job-anxiety is distinguishable from trait-anxiety.
Methods Cross-sectional survey of a convenience sample obtained through personal contact distribution. Employees from different professional settings completed an anonymous questionnaire and provided information on their employment status. The State-Trait-Anxiety Inventory (STAI-T) was used to measure trait-anxiety and the Job-Anxiety-Scale (JAS) was used to assess job (state) anxiety.
Results There was a 69% response rate (240 responses); 188 responses were available for analysis of whom 62% were women. There were no employees with high trait-anxiety. Ten employees (5%) reported increased job-anxiety and of these nine employees reported high 'tendencies of avoidance and workplace absence'. Avoidance was most often accompanied by the comorbid job-anxieties 'job-related social anxiety', 'fear of changes at work' and 'fears of existence', 'anticipatory' and 'conditioned' job-anxiety and 'panic symptoms'.
Conclusions In this sample, self-reported job-anxiety appeared as a specific type of anxiety as opposed to trait-anxiety. In the workplace job-anxiety can present as job-avoidance and sickness absence and should be distinguished from trait-anxiety. In practice, employers and occupational health practitioners should be aware of those employees prone to sickness absence.
Background: Occupational therapy is an important co-therapy in psychiatric therapy. It is a common belief that no risks are associated with occupational therapy. Negative effects caused by group therapy, especially occupational therapy, have not been in the focus of research yet. In this study we want to illustrate possible types and intensities of group side effects through occupational therapy. Patients and Methods: Patients of an inpatient rehabilitation facility filled out the Adverse Treatment Reaction Group Checklist. The checklist contains 47 items divided in six dimensions: group size, content, group participants, group outcome and global. The self-rating used a 5-point likert scale (0 = not at all; 4 = verymuch, extremely stressful) and gives information about types and intensities of the side effects. Results: 88.9 % of 45 patients reported negative effects of occupational group therapy. 28.9 % of the patients rated the side effect as at least severe. Discussion: Occupational therapy is associated with side effects as every other group therapy. Possible side effects caused by group therapy should be considered while planning and implementing occupational therapy.
Work anxiety is a potentially disabling mental health problem, which can cause (long-term) sickness absence. In many cases patients do not openly report their anxieties and tend to give externalizing explanations of inner problems. Therefore people with work anxiety may perceive their workplace more negatively than those without such anxiety. To investigate the relation between subjective work description and work anxiety. There were 148 inpatient participants and 8015 general population controls. Patients with work anxiety described their workplace significantly more negatively than patients without work anxiety and employees in the general population, with no differences in workplace descriptions between psychosomatic patients without work anxiety and the general population sample. The type of complaint about work conditions was related to the specific type of work anxiety. Reports about workplace burdens can be indicative of work anxiety and should prompt further in-depth assessments. The content of complaints about work conditions may point to the type of underlying work anxiety.
Hintergrund: Rehabilitationsmedizin ist nach § 2 und § 26 SGB IX die medizinische Spezialdisziplin zur Vorbeugung, Diagnostik und Behandlung chronischer Erkrankungen. Dies betrifft in besonderem Maße psychische Erkrankungen. Die Behandlung chronischer Erkrankungen erfordert in der Regel eine komplexe und multimodale Langzeitbetreuung, bei der niedergelassenen Ärzten eine zentrale Rolle zukommt. Allerdings gibt es bislang nur wenig ausgearbeitete Konzepte zu den rehabilitationsmedizinischen Aufgaben niedergelassener Ärzte und den ihnen zur Verfügung stehenden diesbezüglichen Behandlungsoptionen.
Methoden: Zur Klärung der Frage, welche Rolle rehamedizinische Aspekte in der Hausarztpraxis haben, wurden im ersten Schritt 40 niedergelassene Ärzte zum geschätzten Anteil chronisch psychisch kranker Patienten in ihrer Praxis befragt.
Im zweiten Schritt wurden 1 451 Patienten im Alter von 18 bis 60 Jahren mittels des WHO-5-Screenings zum psychischen Wohlbefinden, dem IMET-Fragebogen zu Teilhabestörungen, der Burvillskala zur Multimorbidität und Fragen zum psychischen Erkrankungsstatus und Arbeitsstatus untersucht.
Ergebnisse:Im Durchschnitt schätzten die Hausärzte den Anteil ihrer Patienten mit psychischen Erkrankungen auf 41,9% (SD=18,2; Range 15-90%).Von den Patienten gaben 46,5% an, unter psychischen Beschwerden zu leiden. 38,3% der Patienten sagten, dass die Probleme bereits seit 6 Monaten oder länger bestehen (chronisch), und 26,9% erklärten, dass sie die Beschwerden in den letzten 6 Monaten durchgängig erlebt haben (persistierend). Insgesamt litten 29,7% der 18- bis 60-jährigen Hausarztpatienten unter chronischen psychischen Beschwerden mit zusätzlich relevanten Teilhabestörungen.
Schlussfolgerungen: Patienten mit chronischen psychischen Problemen und Teilhabestörungen sind in Praxen niedergelassener Ärzte häufig anzutreffen. Niedergelassene Ärzte und insbesondere Hausärzte sind demnach zu einem wesentlichen Teil ihrer Tätigkeit als Rehabilitationsmediziner anzusehen. In ihren Händen liegt die Diagnostik, Behandlung, Koordinierung und Langzeitführung der chronisch Kranken, wie auch die sozialmedizinische Betreuung, von der Feststellung einer Arbeitsunfähigkeit bis hin zur Einleitung stationärer Rehamaßnahmen. Die Bedeutung der niedergelassenen Ärzte im Rehaprozess verdient organisatorisch wie wissenschaftlich mehr Aufmerksamkeit.
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 (N = 159) and two control groups (N = 450). 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 an increase 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.