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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic posed major challenges to the healthcare system worldwide and led to particular stress among healthcare workers. The aim of this analysis was to investigate the level of global mental stress of direct healthcare workers in Germany during the COVID-19 pandemic. METHODS: In this prospective cross-sectional study with four measurement points (T1: 4-5/2020, T2:11/2020-1/2021, 5-7/2021, 2-5/2022), psychological distress symptoms were recorded in an online survey with the Patient Health Questionnaire (PHQ-4) among hospital staff working in direct patient care (Nâ¯= 5408 datasets). The total dataset was exploratively analyzed according to field of activity, gender, and professional group affiliation. RESULTS: Clinically relevant psychological distress (PHQ-4â¯≥ 5) was present in 29.3% (nâ¯= 419/1429) of intensive care staff. A comparison of the four cross-sectional surveys showed a significant increase in the rate of clinically relevant mental distress in the first pandemic year (23.2% at T1 vs. 30.6% at T2; pâ¯< 0.01), which stabilized at a high level in the second pandemic year (33.6% at T3 and 32.0% at T4). Women did not differ from men in this respect (nâ¯= 280/919, 30.4% vs. nâ¯= 139/508, 27.4%; pâ¯= 0.74). Nursing staff were significantly more often psychologically stressed than physicians (nâ¯= 339/1105, 30.7% vs. nâ¯= 80/324, 24.7%; pâ¯= 0.03). Intensive care staff did not show significantly higher stress than staff working in nonintensive care areas (nâ¯= 419/1429, 29.3% vs. nâ¯= 1149/3979, 28.7%, pâ¯= 0.21). CONCLUSION: German healthcare workers reported high levels of mental distress during the pandemic, which increased during the course of the pandemic, but no significant difference was found between intensive care and nonintensive care staff in our sample. This may be due to the fact that the pandemic in Germany was comparatively moderate internationally and neither a collapse of the healthcare system in general nor a collapse of intensive care structures in particular took place.
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BACKGROUND AND OBJECTIVE: The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course. METHODS: The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment. RESULTS: In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre. CONCLUSIONS: Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.
Subject(s)
COVID-19 , Mental Health , Patient Reported Outcome Measures , Post-Acute COVID-19 Syndrome , Humans , COVID-19/psychology , Male , Female , Middle Aged , Prospective Studies , Adult , Follow-Up Studies , Aged , SARS-CoV-2 , Depression/epidemiology , Depression/etiology , Surveys and Questionnaires , Anxiety/epidemiology , Fatigue/etiologyABSTRACT
The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, Ï = .156) (all other Ïs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all Ïs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all ßs ≤ |.030|, anxiety: all ßs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.
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BACKGROUND: Risk factors for mental health can be found in socio-economic-, gender- and migration-specific inequalities. These factors and the extent of depression, anxiety, and somatization among employees were examined in the present study. METHODS: As part of the Early Intervention in the Workplace Study (friaa), mentally burdened employees at five locations in Germany were surveyed on socio-demographic-, work-, migration-, and health-related content. Regression analyses were used to examine the relationship between these factors and depression (Patient-Health-Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-2, GAD-2), and somatization (Somatic Symptom Scale-8, SSS-8) in the entire sample and in people with migration background (MB). For the latter, acculturation (Frankfurt Acculturation Scale, FRACC) and the perception of burden in terms of demands of immigration (Demands of Immigration Scale, DIS) were also taken into account. RESULTS: On average, the 550 employees (12% with MB) showed clinically relevant depression (Mâ¯= 13.0, SDâ¯= 5.1) (PHQ-9â¯≥ 10), anxiety (Mâ¯= 3.5, SDâ¯= 1.7) (GADâ¯≥ 3) and somatization (Mâ¯= 13.0, SDâ¯= 5.8) (SSS-8â¯≥ 12). Female gender was associated with higher anxiety and somatization. Older age and night shift work were associated with higher somatization. DISCUSSION: The results confirm the high level of mental burden among this sample of employees in Germany. In order to maintain their mental health, support measures should be offered, especially for vulnerable groups such as women, older employees, and night shift workers.
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Workplace , Humans , Germany/epidemiology , Male , Female , Adult , Middle Aged , Workplace/psychology , Socioeconomic Factors , Sex Distribution , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Young Adult , Health Status Disparities , Risk Factors , Occupational Diseases/epidemiology , Occupational Diseases/psychology , Anxiety Disorders/epidemiology , Anxiety Disorders/psychologyABSTRACT
OBJECTIVE: This study aimed to assess subjective and objective parameters of stress among nurses during the COVID-19 pandemic and to examine the recovery effect of a day off. METHODS: In this prospective observational trial, we measured heart rate variability (using a wearable device) and perceived stress levels on 3 working days and 1 day off. We obtained the following data using an online questionnaire: working conditions, COVID-19-related problems, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), effort-reward imbalance, and work-family conflict in a sample of German nurses (N = 41). RESULTS: When comparing working days with a day off, we observed a significant difference for physical load (Cohen's d = 0.798, P < .001), mental load (Cohen's d = 0.660, P = .001), emotional exhaustion (Cohen's d = 0.945, P < .001), and overburdening (Cohen's d = 0.585, P = .002) with higher scores on working days. Regarding heart rate variability, we did not find a difference. Correlational analyses revealed a significant association between being afraid to get infected with COVID-19 and lower heart rate variability (r = -0.336, P = .045) and between being afraid to infect relatives and lower heart rate variability (r = -0.442, P = .007). Furthermore, a higher total sum score of work-family conflict was significantly associated with lower heart rate variability (r = -0.424, P = .01). CONCLUSION: As heart rate variability observations were different from those regarding subjectively perceived stress, further studies are needed to evaluate and differentiate the influence of work stress and other types of stress on heart rate variability.
Subject(s)
COVID-19 , Heart Rate , Humans , COVID-19/psychology , COVID-19/nursing , Female , Heart Rate/physiology , Prospective Studies , Adult , Male , Surveys and Questionnaires , Germany/epidemiology , Occupational Stress , Stress, Psychological , Middle Aged , Nurses/psychology , Pandemics , SARS-CoV-2ABSTRACT
BACKGROUND: Psychotherapy for post-traumatic stress disorder, in particular trauma-confronting psychotherapy, can be associated with increased stress. However, research on the somatic impact and psychosomatic interactions of these psychological stress reactions is lacking. We report on a 43-year old man whose central serous chorioretinopathy exacerbated upon trauma-confronting psychotherapy. CASE PRESENTATION: We report on a man with pre-diagnosed, asymptomatic central serous chorioretinopathy who underwent inpatient psychosomatic therapy. He disclosed a history of sexual abuse by a family member and consequently showed intrusions, flashbacks, nightmares, avoidance behavior, and hyperarousal. Thus, we diagnosed post-traumatic stress disorder. After a stabilization phase, he underwent trauma-focused psychotherapy including trauma confrontation. In the course of this treatment, acute vision loss with blurred vision and image distortion of his right eye occurred. An ophthalmologic visit confirmed a relapse of a pre-diagnosed central serous chorioretinopathy. The analysis of stress biomarkers showed a decrease in testosterone levels and a noon peak in diurnal cortisol secretion, which is indicative of a stress reaction. CONCLUSION: Central serous chorioretinopathy may exacerbate upon psychotherapeutic treatment. In this case, an exacerbation of chorioretinopathy was observed in direct relation to the therapeutic intervention. Psychotherapists and ophthalmologists should collaborate in the psychotherapeutic treatment of patients with chorioretinopathy. Our case demonstrates the need to consider the possible increased stress levels during psychotherapy and resulting physical side effects, such as exacerbation of an existing condition. It is advisable to adjust the level of generated stress particularly well in the presence of stress-inducible physical diseases. Our case is a good example of the interplay between psychological and physical stress.
Subject(s)
Central Serous Chorioretinopathy , Psychotherapy , Stress Disorders, Post-Traumatic , Humans , Central Serous Chorioretinopathy/psychology , Male , Adult , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/psychology , Psychotherapy/methodsABSTRACT
The pathophysiology of posttraumatic stress disorder (PTSD) is associated with the activation of the innate immune system, including cytokines like interleukin 6 (IL-6). However, the role of IL-6 in the etiology and treatment of PTSD still remains elusive. We conducted a prospective controlled trial to investigate the development of IL-6 during psychosomatic treatment in individuals with PTSD in comparison with individuals without PTSD. We assessed IL-6 mRNA expression before and after 2 months of psychosomatic treatment in individuals with and without PTSD. Severities of PTSD and depressive symptoms were assessed in parallel. Linear mixed regression was applied for statistical analysis, including the factors diagnosis PTSD and pre-post treatment after subgrouping for intake of anti-inflammatory drugs. The development of IL-6 mRNA expression during treatment was affected by the use of anti-inflammatory drugs. In the subgroup without intake of anti-inflammatory drugs, no significant statistical treatment effect in individuals with and without PTSD emerged. In the subgroup of individuals taking anti-inflammatory drugs, a significant interaction effect of the factors pre-post treatment and diagnosis PTSD was observed. Whereas IL-6 mRNA expression in individuals without PTSD decreased according to amelioration of symptoms, IL-6 mRNA expression in individuals with PTSD increased significantly during treatment, in opposite direction to symptom severity. Anti-inflammatory drugs might affect IL-6 mRNA expression in individuals with PTSD in a paradoxical way. This study offers a further piece of evidence that IL-6 could be involved in the pathophysiology of PTSD and PTSD-specific immunologic molecular mechanisms.
Subject(s)
Anti-Inflammatory Agents , Interleukin-6 , RNA, Messenger , Stress Disorders, Post-Traumatic , Humans , Stress Disorders, Post-Traumatic/drug therapy , Stress Disorders, Post-Traumatic/genetics , Stress Disorders, Post-Traumatic/metabolism , Male , Interleukin-6/genetics , RNA, Messenger/metabolism , Adult , Female , Middle Aged , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/administration & dosage , Prospective Studies , Depression/drug therapyABSTRACT
AIMS: To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population. BACKGROUND: The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain. DESIGN: A multicentre prospective longitudinal study. METHODS: Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined. RESULTS: Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4). CONCLUSION: During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health. RELEVANCE TO CLINICAL PRACTICE: The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals. IMPLICATIONS FOR THE PROFESSION: Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method. PATIENT CONTRIBUTION: Five hundred and seven nurses completed the questionnaire and provided data for analysis. TRIAL AND PROTOCOL REGISTRATION: The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.
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BACKGROUND: Migrants and refugees/asylum seekers, as a large part of the European work force, are often confronted with unfavorable working conditions in the host country. Main aim of this systematic review was to compare the association of these working conditions with mental health between migrants and refugees/asylum seekers due to their diverse migration experiences and cultural origins, and between different European host countries. METHODS: Systematic search for eligible primary studies was conducted in three electronic databases (PubMed/MEDLINE, PsycINFO and CINAHL) using quantitative study designs written in English, German, French, Italian, Polish, Spanish or Turkish and published from January 1, 2016 to October 27, 2022. Primary health outcomes were diagnosed psychiatric and psychological disorders, suicide and suicide attempts, psychiatric and psychological symptoms, and perceived distress. Secondary health outcomes were more general concepts of mental health such as well-being, life satisfaction and quality of life. Two reviewers independently completed screening, data extraction and the methodological quality assessment of primary studies using the Newcastle-Ottawa-Scale. Descriptive summary of primary studies on working conditions and their relationship with mental health were conducted, comparing migrants and refugees/asylum seekers, migrants and refugees/asylum seekers of different cultural backgrounds (collectivistic and individualistic) and migrants and refugees/asylum seekers living in different host countries. RESULTS: Inclusion criteria were met by 19 primary studies. Voluntary migrants are more likely to experience overqualification in the host country than refugees. In all examined host countries, migrants and refugees suffer from unfavorable working conditions, with migrants from collectivistic countries being slightly at risk compared to migrants from individualistic countries. Most unfavorable working conditions are related to poor mental health, regardless of migrant status, cultural origin or host country. CONCLUSIONS: Although the results should be interpreted with caution due to the small number of studies, it is evident that to maintain both the mental health and labor force of migrants and refugees/asylum seekers, their working conditions in host countries should be controlled and improved. Special attention should be paid to specific subgroups such as migrants from collectivistic societies. ETHICS AND DISSEMINATION: This systematic review is excluded from ethical approval because it used previously approved published data from primary studies. TRIAL REGISTRATION NUMBER: CRD42021244840.
Subject(s)
Refugees , Transients and Migrants , Workplace , Humans , Europe/epidemiology , Mental Health , Quality of Life , Refugees/psychologyABSTRACT
Background: The COVID-19 pandemic had serious impact on the well-being of health care workers and highlighted the need for resources to help hospital staff to cope with psychologically negative consequences. The purpose of this study was to investigate the potentially protective effect of spirituality, as measured by the construct of transpersonal trust, against anxiety in physicians and in hospital pastoral care workers. In addition, transpersonal trust was compared to the effects of other potential resources, namely sense of coherence, optimism, and resilience. We also explored the relationship between transpersonal trust and anxiety and how it was moderated by sense of coherence and expected a significant effect. Method: The sample included N = 405 participants (n = 151 pastoral care workers and n = 254 physicians) who completed an online survey during the first wave of the COVID-19 pandemic between 20th April and 05th July, 2020, that comprised established questionnaires assessing anxiety, transpersonal trust, sense of coherence, and resilience. Results: There was no statistically significant negative relationship between transpersonal trust and anxiety in either profession or broken down by occupational group. Multiple regression analysis revealed that sense of coherence inversely predicted generalized anxiety, while transpersonal trust, resilience, and optimism did not. As hypothesized, the association between transpersonal trust and anxiety was moderated by sense of coherence. However, we could not confirm our hypothesis of a protective effect of transpersonal trust against anxiety. Conclusion: Our results point to the significant role of sense of coherence as a protective factor against anxiety and highlight the complexity of the relationship among spirituality, transpersonal trust, and anxiety.
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BACKGROUND: Team cohesion is a crucial factor when it comes to job satisfaction and turnovers. However, in Germany, economic measures for team cohesion are scarce. The aim of this study was to develop and validate an economic self-report questionnaire for measuring team cohesion in a work setting in health care. METHODS: The questionnaire was developed in a stepwise procedure. After item analysis, exploratory factor analysis was conducted to assess factor structure. Reliability was tested via internal consistency. To assess convergent and divergent validity, we applied the Copenhagen Psychosocial Questionnaire (COPSOQ), the Perceived Cohesion Scale (PCS), the ENRICHD Social Support Inventory (ESSI), the Effort-Reward Imbalance Scale (ERI) and the Patient Health Questionnaire (PHQ-4), respectively. RESULTS: The pilot version was tested in a sample of n = 126 adult nurses. Item analysis resulted in a total of 13 items for the final version. Exploratory factor analysis indicated a two-factor structure. Internal consistency for the two subscales was good, with α = 0.88 and α = 0.84, respectively. Convergent validity with the subscales of COPSOQ and PCS was moderate to high (r =.26- r =.64). For divergent validity, correlations with the ESSI were low (r =.01- r = -.09). We further found significant correlations with depression symptoms (r=-.22- r=-.37), as well as reward (ERI) (r =.41 -r =.47) and effort (ERI) (r=-.20 - r = -.24). CONCLUSIONS: We developed and validated the Erlangen Team Cohesion at Work Scale (ETC), a self-report measure for team cohesion with very good psychometric properties. Due to its economic deployment, it is suitable for measuring team cohesion in work settings, especially in health care.
Subject(s)
Job Satisfaction , Workplace , Adult , Humans , Reproducibility of Results , Surveys and Questionnaires , Workplace/psychology , Self Report , PsychometricsABSTRACT
BACKGROUND: This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years. METHODS: At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported. RESULTS: The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively. CONCLUSIONS: Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established. TRIAL REGISTRATION: The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.
Subject(s)
COVID-19 , Physicians , Male , Humans , Female , Adolescent , Young Adult , Adult , COVID-19/epidemiology , Pandemics , Anxiety/epidemiology , Hospitals , Depression/epidemiologyABSTRACT
Background: Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. Methods: Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. Results: 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4-5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from d = 0.78 to d = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. Conclusions: Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. Clinical trial registration: https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412.
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OBJECTIVE: Dissociative disorders are common in psychiatric patients and severely impact patients' lives. They are, however, underdiagnosed, thus preventing patients from accessing timely and adequate therapy. Identifying how patients with dissociative disorders relate to themselves could improve diagnostics. However, this question has not been explored in detail. The aim of the study was to gain insights into how people with complex dissociative disorders relate to themselves. METHOD: We conducted semistructured qualitative interviews with ten women diagnosed with complex dissociative disorders who had previously completed trauma-focused therapy. Data were analyzed through reflexive thematic analysis. RESULTS: Participants described their behavior toward themselves before the start of the therapy as "autopilot-functional" and "self-destructive." The "autopilot functionality" was characterized by being outward-oriented and ignoring one's own needs. Hence, participants only appeared to be functional. "Self-destructive behavior" was described as a spectrum of various destructive behaviors (e.g., eating disorders, self-harm, excessive exercise, and substance abuse) that participants perceived as a cohesive complex. The participants illustrated that both behaviors were driven by a lack of self-empathy and connected to suppression and poor perception of bodily stimuli. CONCLUSIONS: "Autopilot functionality" seems to be a hallmark in patients with complex dissociative disorders. With patients hiding their self-destructive behavior, health personnel may misjudge the severity of these patients' mental illness. Neither "autopilot functionality" nor "self-destructive behavior" should be judged (neither negatively nor positively), but one should understand both as a coping mechanism for trauma-related disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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OBJECTIVE: The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1. METHODS: In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2). RESULTS: The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician. CONCLUSION: The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.
Subject(s)
COVID-19 , Occupational Stress , Male , Humans , Female , Prevalence , Working Conditions , COVID-19/epidemiology , Pandemics , Health Personnel , Occupational Stress/epidemiology , RewardABSTRACT
BACKGROUND: Persistent cognitive complaints belong to the most frequent symptoms after COVID-19. This study explored the neuropsychological profile, mental health and risk factors for cognitive impairment in post-COVID-19 patients. METHODS: The patients were recruited consecutively in the Post COVID Center of the University Hospital of Erlangen between 12/2022 and 05/2023. They underwent an extensive neuropsychological assessment including the Verbal Learning Memory Test (VLMT), the digit span backwards from the Wechsler Memory Scale-Revised (WMS-R), the Trail Making Test (TMT) Part A and B, the d2 Test of Attention and the Regensburger Verbal Fluency Test (RWT). For each cognitive domain we calculated the frequency of age-adjusted scores below the measure-specific norms. Depressive symptoms were measured with the Patient-Health-Questionnaire-9 (PHQ-9). Logistic regression analyses were computed. RESULTS: In 110 patients (mean age: 42.5 ± 11.9 years; 68.2% women), the most frequent cognitive deficits were observed for verbal fluency, working speed, delayed recall and attention. In almost every cognitive domain high education levels were associated with a decreased risk for cognitive impairment. Higher age was a risk factor for working speed and delayed recall and a protective factor for verbal fluency. Clinically relevant depressive symptoms were associated with an elevated risk for an impairment regarding some cognitive functions. CONCLUSION: Cognitive dysfunctions were common among the post-COVID-19 patients. Differentiated exploration of cognitive impairments is crucial for a proper characterization of the post-COVID syndrome. In future research parameters of cognitive impairment should be correlated to alterations in biological markers of the disease like markers of immunological and microcirculation change.
Subject(s)
COVID-19 , Cognitive Dysfunction , Humans , Female , Adult , Middle Aged , Male , Cross-Sectional Studies , Mental Health , COVID-19/complications , Cognitive Dysfunction/etiology , Cognition , Neuropsychological TestsABSTRACT
Objective: The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD. Method: Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor. Results: The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales. Conclusion: Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.
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OBJECTIVE: Migrants and refugees/asylum seekers make up a significant proportion of the European workforce. They often suffer from poor working conditions, which might impact mental health. The main objective of this systematic review was to summarize and analyze existing research on working conditions of migrants and refugees/asylum seekers in European host countries and compare them to those of natives. Furthermore, the relationship between working conditions and mental health of migrants/refugees/asylum seekers and natives will be compared. METHODS: Three electronic databases (PubMed/MEDLINE, PsycInfo and CINAHL) were systematically searched for eligible articles using quantitative study designs written in English, German, French, Italian, Polish, Spanish or Turkish and published from January 1, 2016 to October 27, 2022. Primary health outcomes were diagnosed psychiatric and psychological disorders, suicide (attempts), psychiatric and psychological symptoms, and perceived distress. Secondary health outcomes were more general concepts of mental health such as well-being, life satisfaction and quality of life. Screening, data extraction and the methodological quality assessment of primary studies by using the Newcastle-Ottawa Scale were done independently by two reviewers. The results of the primary studies were summarized descriptively. Migrants and refugees/asylum seekers were compared with natives in terms of the association between working conditions and mental health. RESULTS: Migrants and refugees often face disadvantages at work concerning organizational (low-skilled work, overqualification, fixed-term contracts, shift work, lower reward levels) and social conditions (discrimination experiences) in contrast to natives. Most unfavorable working conditions are associated with worse mental health for migrants as well as for natives. CONCLUSIONS: Even if the results are to be taken with caution, it is necessary to control and improve the working conditions of migrants and refugees/asylum seekers and adapt them to those of the native population to maintain their mental health and thus their labor force.
Subject(s)
Refugees , Transients and Migrants , Humans , Mental Health , Refugees/psychology , Quality of Life , Working Conditions , Europe/epidemiologyABSTRACT
BACKGROUND: The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest. METHODS: Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined. RESULTS: At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23). CONCLUSIONS: During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.
Subject(s)
COVID-19 , Physicians , Humans , Cross-Sectional Studies , Pandemics , Quality of Life , Prospective Studies , COVID-19/epidemiology , Anxiety/epidemiology , Ambulatory Care , Depression/epidemiologyABSTRACT
BACKGROUND: Due to a variety of symptoms and side-effects of cancer treatment, quality of life can be considerably impaired in cancer patients. Especially, cancer patients with a migration background seem to be at risk. The objective of our study is to investigate the quality of life and sense of coherence in adult cancer patients of German, Turkish and Polish origin. METHODS: We assessed sociodemographic, migration-specific and cancer-related parameters. Quality of life was measured via the EORTC QLQ-C30, sense of coherence was measured with the SOC-13. RESULTS: We included 227 patients in the study (59.5% native Germans, 40.5% with migration background). Native Germans did not differ in quality of life compared to all migrants. However, more nausea and vomiting (NV) and higher appetite loss (AP) was found in Turkish migrants compared to Polish migrants and native Germans. For sense of coherence, we observed significantly higher scores for native Germans compared to all migrants. Turkish migrants had significantly lower scores compared to native Germans. CONCLUSIONS: A Turkish migration background seems to play an important role in the perception of symptoms, especially of nausea and vomiting and appetite loss. Culture-specific aspects should be considered in cancer care.