[Mental health problems among employees: service use and costs to the German healthcare system]. / Psychische Belastungen bei Erwerbstätigen: Leistungsinanspruchnahme und Kosten für das deutsche Gesundheitssystem.

BACKGROUND: Service use among employees with mental health problems and the associated costs for the health and social system have not yet been systematically analysed in studies or have only been recorded indirectly. The aim of this article is to report the service use in this target group, to estimate the costs for the health and social system and to identify possible influencing factors on the cost variance. METHODS: As part of a multicentre study, use and costs of health and social services were examined for a sample of 550 employees with mental health problems. Service use was recorded using the German version of the Client Sociodemographic Service Receipt Inventory (CSSRI). Costs were calculated for six months. A generalized linear regression model was used to examine influencing cost factors. RESULTS: At the start of the study, the average total costs for the past six months in the sample were €â€¯5227.12 per person (standard deviation €â€¯7704.21). The regression model indicates significant associations between increasing costs with increasing age and for people with depression, behavioural syndromes with physiological symptoms, and other diagnoses. DISCUSSION: The calculated costs were similar in comparison to clinical samples. It should be further examined in longitudinal studies whether this result changes through specific interventions.

[Psychosomatic Rehabilitation for Post-COVID]. / Psychosomatische Rehabilitation bei Post-COVID.

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

Outpatient follow-up of tumour diseases through video-based value-oriented behavioural activation (ViVA): study protocol for a randomised controlled trial.

BACKGROUND: In Germany, approximately half a million people are diagnosed with cancer annually; this can be traumatic and lead to depression, anxiety, and adjustment disorders necessitating psycho-oncological intervention. Value-oriented behavioural activation, adopted from depression psychotherapy, aims to provide structured support to help patients adjust their personal values, goals, and activities within the context of their changed life situation. This trial aims to evaluate the effectiveness of video-based value-oriented behavioural activation against German S3-Guideline-compliant aftercare for cancer patients dealing with psychological distress. METHODS: This trial will use covariate-adaptive randomisation according to gender and type of tumour disease to assign participants to one of two study arms (value-oriented behavioural activation consisting of 12 manualised follow-up sessions delivered via video consultation vs. S3-Guideline-compliant aftercare comprising three supportive talks). Psychological strain, psychosocial distress, quality of life, work-related outcomes, fear of cancer recurrence, goal adjustment, satisfaction with the consultant-participant relationship, and rumination will be measured at baseline, twice during treatment, posttreatment, and at the 6-month follow-up. The target sample of 146 tumour patients experiencing high psychosocial distress will be recruited at the Rehazentrum Oberharz, Germany. DISCUSSION: This trial aims to test the effectiveness of value-oriented behavioural activation in aftercare for tumour patients, focusing on its capacity to reduce distress and the potential for long-term effects evaluated through a 6-month follow-up. The study's possible challenges include enrolling a sufficient sample and ensuring adherence to treatment, mitigated through in-person recruitment and rigorous training of staff. If successful, the results will be of high public health relevance, especially for psychotherapeutic care in rural areas and among patients with limited mobility considering the video-based approach of the trial. TRIAL REGISTRATION: This study was registered at the German Clinical Trials Register: DRKS00031900 on Sep 19, 2023.

Improvement of Work Ability After Weight Loss Surgery: Results of a Longitudinal Study of Patients Suffering from Extreme Obesity Before and 4 Years After Bariatric Surgery.

PURPOSE: Body mass index (BMI) is directly associated with employment status. Our longitudinal prospective study is aimed at ascertaining whether work ability index (WAI) 4 years after surgery remains improved, such as 1 year after surgery, or changes and whether socio-demographic or psycho-social factors influence changes in work ability. MATERIALS AND METHODS: 197 bariatric surgery candidates were recruited. Data on demographic and psycho-social characteristics were collected prior to surgery (t1) and at 6 (t2), 12 (t3), and 48 months (t4). Change effects over time in the WAI and BMI were investigated using a repeated-measures analysis of variance (ANOVA). A hierarchical multiple regression analysis was calculated to predict socio-demographic and psychosocial characteristics at t1 on WAI at t4. RESULTS: Not only a significant increase in WAI was observed between t1 and t2 and between t3 and t4 but also a significant decrease between t2 and t4. BMI reduction was significant between t1 and t2 and t3 and t4, respectively. There was no significant interaction effect of BMI reduction 4 years after surgery on decreased work ability from t2 to t4. The hierarchical multiple regression analysis revealed an association of WAI scores at t1 on WAI scores at t4 only. CONCLUSIONS: Work ability 4 years after surgery remained significantly improved compared to the values at t1-t3 assessment. Since work ability was the only predictor at t1, findings might indicate the use of psycho-social measures post bariatric surgery to increase work ability. There was no association between work ability and other socio-demographic or psycho-social factors.

Changes in Work Ability after Weight-Loss Surgery: Results of a Longitudinal Study of Persons with Morbid Obesity before and after Bariatric Surgery.

INTRODUCTION: Bariatric surgery is a life-changing treatment, but knowledge of its influence on changes in work ability is still limited. We hypothesized that self-reported work ability improves in response to surgery-induced weight loss and sociodemographical variables (e.g., age, sex, and marital status), and that psychosocial characteristics (e.g., depressive symptoms and dysfunctional eating) may have predictive value as to patients' work ability. METHODS: A total of 200 participants scheduled for bariatric surgery were recruited between September 2015 and June 2018. They completed several self-report measures at the preoperative examination (t1) and at 6- (t2) and 12 months (t3) after bariatric surgery. A repeated-measures analysis of variance was calculated to detect any changes in the work ability and body mass index (BMI) among the 3 time points. Further, a hierarchical multiple regression analysis was used to determine whether any demographical and psychosocial characteristics at (t1) would predict work ability at (t3). RESULTS: Participants (82% of whom were women) were middle-aged and showed a BMI of nearly 46 at the preoperative medical examination. Excess weight loss at (t2) and at (t3) was 49 and 66%, respectively. Work ability increased toward a moderate level after weight-loss surgery. Work ability and dysfunctional eating at (t1) showed significant predictive value with respect to work ability at (t3). DISCUSSION: The results suggest that weight-loss surgery has a positive impact on work ability, and indicate a predictive value for the extent of weight loss and dysfunctional eating behavior. Against our hypothesis and in contrast to former research, a predictive value for depressive symptoms and age was not revealed. Further research must show how interventions can support and maintain improvements in work ability after bariatric surgery, in order to reduce sick leave and unemployment in patients with preoperative morbid obesity.

Changes in Patients' Relationship Satisfaction After Weight Loss Surgery: Results of a Study of Persons with Morbid Obesity and Their Relationship Satisfaction Before and 1 Year After Bariatric Surgery.

OBJECTIVE: Bariatric surgery is a life-changing treatment, but knowledge of its influence on changes in relationship satisfaction (RS) is still limited. The present study examines whether a patient's RS changes after having bariatric surgery, in response to the surgery-induced weight loss. The predictive value of further variables such as age and sex are also investigated. METHODS: A total of 145 participants scheduled for bariatric surgery were recruited between September 2015 and June 2018. RS was assessed with a reliable and valid short form of a standardized self-report measure, which was completed before, 6 months and 12 months after surgery. RESULTS: Loss of excess weight at 6 and 12 months post-surgery was 49% and 66.3%, respectively. The repeated measures ANOVA for the factor "PFB-K" revealed a statistically significant effect, with F (2, 288) = 7.40, p = .001, and η2 = .05, and for the factor "BMI" with F (2, 288) = 505.99, p < .001, and η2 = .78. The highest mean RS score was observed 6 months post-surgery. Sex showed a statistical trend of influence on RS: F (1, 143) = 3.24, p = .074, and η2 = .022. At all three measurement points, men showed higher mean RS scores than women. CONCLUSION: Bariatric surgery leads to significant weight loss and indicates an increase in RS. While a correlation with the amount of weight lost remains unclear, a trend was seen towards higher RS in subjects with higher weight loss. Men in particular reported higher RS.

[Psychological Strain due to Female Genital Mutilation: An Explorative Analysis in the Context of Medical Counselling]. / Psychische Belastung durch weibliche Genitalverstümmelung: Eine explorative Untersuchung im Rahmen einer medizinischen Sprechstunde.

Female genital mutilation (FGM) is a procedure that injures or removes parts of the external female genitals for nonmedical reasons and without the consent of the affected girls. Often this procedure leads to severe consequences for the women's physical and mental health. Reconstructive surgery can reduce these symptoms. In an exploratory study of 97 women seeking medical counselling, characteristics of the sample were analysed descriptively, reasons for reconstructive surgery were examined and agreement between the women's knowledge with the results of the medical examination was assessed. 56.7% (n=55) of the women examined were suspected to suffer from PTSD. Relief of pain was the reason most frequently mentioned for reconstructive surgery (45.4%; n=44). Accordance between women's knowledge of anatomic structures and the degree of mutilation with the results of the medical examination was low (κ=0.09). In addition to surgical measures, women suffering from FGM should be offered psychotherapeutic assistance. To improve the understanding on the effect of psychotherapy after FGM, sound longitudinal studies are indispensable.

Psychosocial Predictors of Work Ability in Morbidly Obese Patients: Results of a Cross-Sectional Study in the Context of Bariatric Surgery.

BACKGROUND: Obesity is associated with a higher risk of work disability and premature early retirement. OBJECTIVE: The aim of this study was to examine psychosocial predictors for work ability prior to surgery. METHODS: Based on a sample of 197 surgery-seeking obese patients (preoperative body mass index [BMI] above 35 kg/m2) from a German bariatric surgery unit, the present cross-sectional study examined based on standardized self-rating measures whether depressive symptoms, dysfunctional eating behaviors, relationship satisfaction, and life satisfaction have a predictive value for work ability. RESULTS: Considerable impairment of work ability was found in 51.8% of morbidly obese participants (n = 102). Multiple regression analyses revealed that older age, greater depressive symptoms, and lower life satisfaction were significant predictors of preoperative work ability. BMI, gender, relationship satisfaction, and dysfunctional eating behaviors did not predict work ability. CONCLUSIONS: Our findings might indicate the use of further psychosocial measures following bariatric surgery to increase work ability.

[The use of E-Cigarettes in the German Population: Results of the Epidemiological Survey of Substance Abuse 2015]. / Die Nutzung von E-Zigaretten in der deutschen Bevölkerung ­ Ergebnisse des Epidemiologischen Suchtsurvey 2015.

AIM: Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented. METHODS: The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis. RESULTS: E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking. CONCLUSION: E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

[E-cigarettes: Perceived harmfulness and use for smoking cessation]. / E-Zigaretten: Einschätzung von Gesundheitsgefahren und Nutzung zur Tabakentwöhnung.

BACKGROUND: The perception that e­cigarettes are less harmful than traditional tobacco products can influence the consumption of e­cigarettes. OBJECTIVES: Three questions were examined: (1) How do different population groups perceive health risks of e­cigarettes? (2) Do sociodemographic variables explain differences in the risk assessment of e­cigarettes? (3) Does the perception of health risks predict the use of e­cigarettes for smoking cessation? METHODS: Data came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with a sample size of n = 9204 participants, aged 18 to 64 years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e­cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed. RESULTS: Individuals with lower education rated e­cigarettes as more harmful. Older people and women perceived e­cigarettes as just as harmful. Smokers considered e­cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e­cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes. CONCLUSIONS: Only one-third of the population knows that e­cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e­cigarettes for smoking cessation.

[Smoke-free psychiatry in Germany: A closer look]. / Rauchfreie Psychiatrie: Eine Bestandsaufnahme.

OBJECTIVE: In order to protect non-smokers, the federal states of Germany have adopted a law that provides for extensive smoking bans. In many of these federal laws, acute psychiatric facilities are treated as an exception. Therefore, it is often up to the institutions themselves to develop and enforce regulations. The aim of this study was to evaluate the situation in acute psychiatric facilities. METHODS: The survey was created on the basis of previously evaluated questionnaires and consisted of 53 questions. A total of 289 hospitals were contacted. Participants were invited to take part in the survey via e-mail. RESULTS: 59 hospitals (20.4 %) participated in the survey. Binding regulations were in place in 48 (81.4 %) hospitals, in 26 (44.1 %), smoking was prohibited on open wards. Three hospitals (5.1 %) strictly prohibited smoking on locked wards. Stop-smoking medication was available in 31 (55.3 %) hospitals. 19 (32.2 %) offered smoking cessation interventions. 22 (37.3 %) hospitals have set up a working group on the subject. CONCLUSION: Currently, the issue of smoking in psychiatric facilities does not receive enough attention. The physical and mental health of psychiatric patients would benefit from a smoke-free policy. In order to achieve this, psychiatric staff and patients need appropriate support.

[Use of E­cigarettes as an additional tool in a smoking cessation group intervention : Results after 12 months]. / Nutzung und Nutzen der E­Zigarette im Rahmen eines strukturierten verhaltenstherapeutischen Gruppenprogramms : Ergebnisse einer 12-Monats-Nachbefragung.

BACKGROUND: E-cigarettes are considerably safer regarding health issues than conventional cigarettes, but there is uncertainty concerning its use for smoking cessation. OBJECTIVES: How and to what extent are E­cigarettes used by smokers willing to quit? Are E­cigarettes a useful intervention for smokers attending a group intervention for smoking cessation? MATERIALS AND METHODS: One year after attending a group intervention for smoking cessation in Germany, 637 attendants were assessed by telephone. The interview topics were the use of E­cigarettes and tobacco abstinence. RESULTS: Of the attendants that could be interviewed, 12.6% had used E­cigarettes during or after the smoking cessation intervention. At the beginning of the intervention these smokers smoked significantly more cigarettes and were more addicted to cigarettes than the other attendants. After one year significantly less E­cigarette users were abstinent compared to participants that used nicotine replacement therapy or no additional smoking cessation aids. CONCLUSIONS: The application of E­cigarettes is counterproductive for smokers looking for help in an abstinence oriented smoking cessation group. The lack of distinct, easy to follow instructions on the use of E­cigarettes as a cessation tool may impair the process of cessation. Without good guidance smokers may get distracted in their motivation and willingness to stop smoking.

Evaluation of the cognitive behavioral smoking reduction program "Smoke_less": a randomized controlled trial.

The vast majority of smokers are unable or unwilling to quit, but many are open to reducing smoking. No treatment options exist for these smokers besides medication-based therapies. Thus, this study investigated the efficacy of a cognitive behavioral therapy (CBT) smoking reduction program, Smoke_less. A sample of 155 outpatient smokers aged 18-70 years was recruited at the Tobacco Dependence Outpatient Clinic of the Medical Center of the University of Munich, Germany, and randomly assigned to the experimental group (Smoke_less: four weekly CBT group sessions and two telephone calls over 5 weeks, n = 51), active comparator group (one 15-minute counseling session, n = 49), or waiting control group (no intervention during the study, n = 55). The primary endpoint was a ≥50% smoking reduction in the intention-to-treat group 1 week and 6 months after the intervention. We evaluated also abstinence rates at follow-up. Significantly more participants in the Smoke_less group had reduced smoking ≥50% compared to the waiting group at 1 week [OR 7.59 (2.59-22.19)] and 6 months [OR 5.00 (1.68-14.84)] and compared to the active comparison group at 1 week [OR 8.58 (2.67-27.31)] but not at 6 months [OR 1.73 (0.71-4.20)]. We found no significant effects on abstinence rates. The CBT smoking reduction program Smoke_less is effective for smoking reduction but is superior to brief counseling only in the short term. Further research is required to improve its efficacy in long-term smoking reduction to provide a valid, non-medication-based alternative to smokers unable or unwilling to quit. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02337400.

[Posttraumatic Stress and Depressive Symptoms amongst Asylum Seekers]. / Posttraumatische und depressive Symptomatik bei Asylsuchenden.

Background and Objectives: Currently, there is a large number of refugees that are coming to Germany from (civil) war zones. The aim of this study was to estimate the extent of posttraumatic stress and depressive symptoms amongst asylum seekers in Germany. Methods: In the summer of 2015, 280 adult refugees (88,2% men) were interviewed with the support of translators in the Lower Saxony State Refugee Reception Center, Brunswick. Data was categorized due to country of origin (Balkan States, Middle East, Northern Africa, Rest of Africa). The Posttraumatic Diagnostic Scale-8 (PDS-8) and the Patient-Health-Questionnaire (PHQ-8) were employed as screening measures. If the threshold values of 12 in the PDS-8 or 15 in the PHQ are exceeded, respectively, the diagnosis of PTSD or depression is highly likely. Results: Participants reported an overall high number of potentially traumatic experiences (72,5% war experiences; 67,9% violent attacks; 51,4% another very burdensome experience; 50,0% torture; 47,9% imprisonment; 11,1% sexual assault), whereby multiple answers were possible. The prevalence rates for possible PTSD were 16,1% (Balkan States), 20,5% (Middle East), 23,4% (Rest of Africa) and 28,1% (Northern Africa); rates for a possible depression varied between the countries of origin from 17,9, 35,9, 28,1 to 24,0%, respectively. Conclusions: Compared to the German population, the rates of traumatic experiences and the prevalence of a possible PTSD were significantly higher amongst asylum seekers of the present sample; this was not the case for depression. The integration of affected asylum seekers may be considerably complicated due to health impairments, e. g. with regard to learning the German language and admission to educational or occupational services.

Smoking Cessation Program for Inpatients with Substance Use Disorder: A Quasi-Randomized Controlled Trial of Feasibility and Efficacy.

AIMS: The present study investigated the feasibility, acceptance and efficacy of a newly developed cognitive behavioral program for smoking cessation/reduction ('Rethink your Smoking' program, RSP) in inpatients with substance use disorder (SUD). METHOD: One hundred ninety-nine inpatients with SUD were randomly assigned to either the RSP (n = 101) or a minimal intervention (MI) program (n = 98). In addition, participants were offered optional nicotine replacement therapy. Data from a group of patients with SUD without any intervention (control group, n = 78) were included in the analyses for comparison. Assessments were performed at admission, discharge and follow-up after 3 and 6 months. RESULTS: RSP proved to be feasible and was well accepted by participants. Patients in both interventions showed lower scores for physical nicotine dependence and number of cigarettes smoked per day and higher scores for various motivational parameters at discharge and 3 months later. Both interventions were superior to no intervention, but no differences were found between the RSP and MI. CONCLUSION: A smoking cessation/reduction program is feasible for substance-dependent in-patients undergoing detoxification. Although the RSP appears to be effective in terms of harm reduction in in-patients with SUD, more cost- and time-efficient programs might also be suitable for this population.

Telephone booster sessions for optimizing smoking cessation for patients in rehabilitation centers.

Smokers with smoking-related diseases who are hospitalized in rehabilitation centers should be offered smoking cessation. This is the first study evaluating whether telephone booster sessions after intensive inpatient treatment are an effective strategy. The present study was conducted in 13 rehabilitation centers for somatic disorders as a prospective multicenter study with a randomized treatment-control group design. We compared abstinence rates after hospital discharge from treatment that included a group smoking cessation program with (treatment group) and without telephone booster sessions (control group). Data from 290 smokers were analyzed. After 6 and 12 months the treatment group achieved abstinence rates twice as high as those of the control group. Men profited more from telephone booster sessions than did women. Results indicated that telephone booster sessions were highly effective (even) after an inherently intensive group program during a hospital stay. Further research should focus on the special needs of women receiving telephone counseling.