The different areas of chronic stress and food addiction: Results from the LIFE-Adult-Study.

There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability of researchers and practitioners to address problematic eating-related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE-Adult-Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self-care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying).

[Burnout in hospital-based surgeons. Approaches for prevention?] / Burn-out bei chirurgisch tätigen Klinikärzten. Ansätze für die Prävention?

BACKGROUND: Burnout among physicians is increasingly recognized as a public health issue including its scientific, political, and societal relevance. The effects of burnout go far beyond physician health as they affect the quality of care, patient safety, medical errors, and efficiency of health care. OBJECTIVE: Assessment of the risk of burnout for hospital-based surgeons as well as associations between surgeon burnout and several work-related and person-related factors. METHODS: From the representative Saxony physician survey from 2019, we utilized the subsample of 231 hospital-based surgeons. We conducted a regression analysis with workload, job satisfaction, work-life balance (WLB), resilience, inability to recover and health complaints as predictors of burnout (Maslach burnout inventory-General survey, MBI-GS). RESULTS: Nearly half of the sample were female (49.4%), the average age was 42.0 years, 4.8% of participants exhibited burnout, 45.9% with some symptoms and 49.4% no burnout. Multivariate analysis showed significant positive associations between health complaints, inability to recover, a lack of job-based self-fulfillment and burnout. There were significant negative connections between WLB, the wish to remain in the job and burnout. CONCLUSION: Burnout is a serious problem for surgeons. Preventive measures should focus on risk factors associated with the workplace and organization of work. Interventions targeted at the individual level should start at an early career stage.

Physical activity and mental health: the connection between step count and depression, anxiety and quality of sleep.

While there are studies connecting everyday physical activity (PA) to mental health, they mostly use self-report measures for PA which are biased in multiple ways. Nevertheless, a realistic assessment of everyday PA is important for the development and implementation of low-threshold public health interventions. Therefore, we want to analyze the relationship between objectively measured daily steps and mental health. We included 1451 subjects from a subsample of the population-based LIFE-Adult-Study (2011-2014) with an average age of 55.0 years, 52.1% were female. We analyzed the effects of PA (step count measured via SenseWear Pro 3) on depression (CES-D), anxiety (GAD-7), and quality of sleep (PSQI). The regression analysis showed a significant negative association between low to moderate PA [Incidence rate ratio: 0.87 (0.77; 0.98)] as well as high to very high PA [0.84 (0.74; 0.95)] and depression and no significant associations between PA and anxiety [l-m: 0.98 (0.81; 1.18)/h-vh: 1.00 (0.82; 1.21)] or quality of sleep [l-m: 0.94 (0.84, 1.06)/h-vh: 0.92 (0.82, 1.03)], controlling for sociodemographic variables and personality. Low-threshold interventions that increase daily step count could be a useful approach for the prevention of depression. The use of objective PA measurement for research is highly encouraged.

Psychosocial Occupational Exposures and Mental Illness.

BACKGROUND: The purpose of this study is to investigate the exposure-risk relationship between psychosocial occupational stress and mental illness. METHODS: We conducted a systematic review with meta-analyses as an update of a systematic review published in 2014. The study protocol was registered in PROSPERO (CRD42020170032). Literature searches were carried out in the MEDLINE, PsycINFO, and Embase databases. All procedural steps were performed independently by two reviewers; discordances were solved by consensus. All of the included full texts were subject to a methodological appraisal. Certainty of evidence was determined with the GRADE procedure. RESULTS: The pooled risk of depression was found to be approximately doubled in workers exposed to high job strain, which is defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI [1.68; 2.35], heterogeneity [I2] = 24.7%, n = 8). In particular, high work demands are associated with incident depression (ES = 13.8 [1.19; 1.61], I2 = 69.0%, n = 9) and with incident anxiety disorder (ES = 1.79 [1.44; 2.23], I2 = 48.1%, n = 5). There were only a small number of methodologically adequate studies available on burnout, somatoform disorders, suicidal ideation, and suicide. Thus, no pooled risk estimates were calculated, although some individual studies showed a considerably increased risk. CONCLUSION: Psychosocial occupational stress is clearly associated with depression and anxiety disorders.

Social network sites as learning environments and their implications for mental health.

Social network sites (SNSs) have become ubiquitous around the globe and interwoven with all aspects of life. In this article, I will argue that the communicative infrastructure of SNSs, i.e., all SNS-elements that allow users to communicate, is a key element for understanding their impact as it creates environments in which users, their behaviors, and social interactions are embedded. These digital environments facilitate and encourage fundamental mechanisms of implicit learning from feedback as well as observation in an unprecedented way. I will discuss how these technology-based learning environments impact the mental health of their users, e.g., by linking negative online feedback to depression and following influencers to disturbed eating. The article ends with a conclusion that emphasizes the advantages of understanding SNSs as environments in order to reflect the complexity, relevance, and ubiquitousness of the phenomenon.

Connecting chronic stress and anxiety: a multi-dimensional perspective.

Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way.

The work-life balance of general practitioners as a predictor of burnout and motivation to stay in the profession.

BACKGROUND: Work-life balance (WLB) is associated with a variety of health-related outcomes in the general population. Since General Practitioners (GPs) play a fundamental role in the health system, we wanted to analyze the associations between their WLB and burnout scores as well as motivation to stay in the profession. METHODS: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 188 GPs that were working full time, 61.7% were female. RESULTS: Multivariate analysis showed a beneficial association between WLB and all three dimensions of burnout (Emotional Exhaustion, Cynicism, and Professional Efficacy) as well as the motivation to stay in the profession. CONCLUSIONS: Improving GPs WLB could be a way to reduce physician burnout, strengthen the healthcare system, and attract a new generation of talented physicians.

Different Areas of Chronic Stress and Their Associations with Depression.

BACKGROUND: Research shows a connection between stress and depression, but there is little differentiation between areas of stress, making it difficult to identify and address specific areas in the context of public health measures. We utilized a multi-dimensional approach to chronic stress to better understand the relationship between different areas of stress and depression. METHODS: We conducted linear regression analyses and used data from a sub-sample of the LIFE-Adult-Study (N = 1008) to analyze the connection between nine different areas of chronic stress (TICS) and depression (CES-D). In the second analysis, we controlled for sociodemographic variables, personality, physical activity, and social support. RESULTS: There was a significant positive association between the stress domains Excessive Demands from Work, Lack of Social Recognition, Social Isolation, and Chronic Worrying and depression and a significant negative association between Pressure to Perform and depression. After adding control variables, only Pressure to Perform, Social Isolation, and Chronic Worrying remained significant predictors. CONCLUSIONS: By focusing on the connections between chronic stress and depression, researchers can help identify the areas that matter most and contribute to the creation of meaningful and efficient interventions. On the basis of our results, measures for the prevention of depression that focus on the reduction of worrying and social isolation are recommended.

Anxiety and Food Addiction in Men and Women: Results From the Longitudinal LIFE-Adult-Study.

Background: Anxiety is a widespread phenomenon, and it is connected to disordered eating and obesity. We want to analyze the connection between anxiety and food addiction (FA) over two points in time to better understand the directionality of the association. Since there are gender differences with regard to anxiety and eating, we are also interested in differences between men and women. Methods: We used data from the population-based LIFE-Adult-Study (N = 1,474) at time 1 (baseline) and time 2 (first follow-up) to analyze the connections between anxiety (GAD-7) and FA (YFAS) using a multiple group latent cross-lagged panel model with female and male participants as groups. We controlled for age, marital status, socioeconomic status and social support. Results: Anxiety (women: ß = 0.50, p ≤ 0.001; men: ß = 0.59, p ≤ 0.001) as well as FA (women: ß = 0.37, p ≤ 0.001; men: ß = 0.58, p ≤ 0.001) exhibited stability over time for both genders. We found a significant association between anxiety at time 1 and FA at time 2 for women (ß = 0.25, p ≤ 0.001) but not for men (ß = 0.04, p = 0.10), and significant associations between FA at time 1 and anxiety at time 2 for women (ß = 0.23, p ≤ 0.001) as well as men (ß = 0.21, p ≤ 0.001). Conclusion: Food addiction longitudinally affects anxiety, independent of gender and other sociodemographic variables. In addition, anxiety affects subsequent FA as well, but only in women. Interventions that address FA could reduce anxiety in men and women, while interventions that mitigate anxiety could help prevent FA in women.

It's about time - Associations between working time dimensions and well-being of physicians.

Several working time characteristics have been linked to negative outcomes for health personnel. The aim was to investigate the impact of working time dimensions on well-being in a representative sample of physicians. Data was collected during a baseline study. Linear regression analysis was performed on a sample including 669 physicians of different medical specialties. The questionnaire included sociodemographic characteristics and information on working time dimensions (e.g. shift work). In addition, job satisfaction, workload and self-reported health were explored. The majority were female, working in internal medicine and the mean age was 42.5 years. Findings reveal that overtime hours (ß = -0.478, p = .011) and autonomy (ß = 0.444, p < .001) were significantly associated with job satisfaction. The number of free weekends (ß = -2.622, p = .005) and autonomy significantly predicted personal (ß = -6.153, p < .001), work-related (ß = -6.597, p < .001) and patient-related workload (ß = -4.731, p < .001). Overall health was only affected by working time autonomy (ß = 3.804, p < .001). In conclusion, the study suggests that working time characteristics have negative consequences for well-being and need to be addressed to ensure health, performance and safety of physicians.

The bright side of social network sites: On the potential of online social capital for mental health.

Social network sites are an essential part of the daily lives of people around the globe, but our theoretical understanding of the phenomenon is still limited. However, to fully grasp the potential of social network sites and to be able to generate meaningful applications, a theoretical understanding of the phenomenon is needed. I want to introduce the concept of online social capital as the first step in this direction, and show how it could be applied to the area of mental health. Therefore, I will (1) bring together social network sites and social capital theory, (2) introduce online social capital with a special focus on its capacity and mobilization as well as on associated processes of relationship maintenance and information search, (3) explore potential implications for mental health promotion, (4) depict the mental health risks that are associated with the use of social network sites, and (5) highlight some areas for future research.

Leipzig - Individual Placement and Support for people with mental illnesses (LIPSY): study protocol of a randomized controlled trial.

BACKGROUND: Individuals receiving means-tested benefits are at a higher risk of being diagnosed with a psychiatric illness compared to those who are employed, and the rate of those working in the first labor market is low. The intervention (Individual Placement and Support, IPS) aims at maintaining or regaining working ability and at facilitating reintegration into the (first) labor market following a "first place, then train"-approach. The objective of the study is to conduct the first RCT in Germany that addresses a broad group of long-term unemployed individuals with severe mental illnesses that receive means-tested benefits, and to test the effectiveness of the IPS intervention. METHODS: In this randomized controlled trial, about 120 eligible participants aged between 18 years and local retirement age will be randomly allocated to an intervention group (IG) or to an active control group (CG) using a parallel arm design. The IG will receive IPS + high quality treatment as usual (TAU), the active CG will receive TAU + a booklet on integration measures. A block-randomization algorithm with a targeted assignment ratio of 1:1 for participants in IG and active CG will be used, stratified by sex and three age groups. Assessments will take place before the intervention at baseline (t0), and 6 (t1), 12 (t2), and 18 (t3) months later. Primary outcome will be the proportion of participants having worked at least 1 day in competitive employment since baseline, as assessed at t3. Secondary outcomes will be related to employment/ vocation and mental health. In addition, there will be a process evaluation. Treatment effects on outcomes will be tested using appropriate panel-data regression models, and acceptability, uptake and adherence will be evaluated using descriptive statistics and appropriate inference testing. DISCUSSION: The results of this trial are expected to generate a better understanding of the efficiency, feasibility, acceptance, and relevance of the IPS intervention in a German setting. They could be a first step towards the implementation of the method and towards improving the situation of long-term unemployed individuals with severe mental health problems. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00023245 ), registered on 22.02.2021.

Burnout and work-life balance among physicians: the role of migration background.

BACKGROUND: We want to analyze the effect of migration background (MB) on physician burnout and work-life balance. METHODS: In September 2019, physicians from various specialties answered a questionnaire on work and health. We analyzed a subsample of 526 physicians that were working full time in a hospital, 14% with an MB and 47.9% were female. RESULTS: Multivariate analysis showed that physicians with an MB exhibit significantly less favorable scores on all three burnout dimensions, and this effect persisted in the regression analysis after adding age, gender, and marital status as control variables. There were no differences with regard to work-life balance. CONCLUSIONS: To our knowledge, our study is the first one to suggest that MB plays a significant role in physician mental health. Future research will benefit from identifying the factors behind that connection, e.g., problems related to acculturation, communication and social integration, which can then be addressed by policymakers in order to maintain and improve the medical infrastructure.

Analyzing the link between anxiety and eating behavior as a potential pathway to eating-related health outcomes.

Anxiety is a widespread phenomenon that affects various behaviors. We want to analyze in how far anxiety is connected to eating behaviors since this is one potential pathway to understanding eating-related health outcomes like obesity or eating disorders. We used data from the population-based LIFE-Adult-Study (n = 5019) to analyze the connection between anxiety (GAD-7) and the three dimensions of eating behaviors (FEV)-Cognitive Restraint, Disinhibition, and Hunger-while controlling for sociodemographic variables, smoking, physical activity, personality, and social support. Multivariate regression analyses showed significant positive associations between anxiety and Disinhibition as well as Hunger, but not between anxiety and Cognitive Restraint. Interventions that help individuals to better regulate and cope with anxiety, could be one potential pathway to reducing eating disorders and obesity in the population.

Depression and quality of life in old age: a closer look.

Depressive disorders are among the most widespread mental disorders in old age, with negative consequences for quality of life (QOL). Understanding QOL as a multidimensional construct, in this article we have a closer look on what specific aspects are affected by depression. We used a representative sample of the German population (n = 805) and one of individuals diagnosed with depression (n = 106) to compare QOL using the WHOQOL-BREF and the WHOQOL-OLD. Multivariate analysis showed that individuals diagnosed with depression exhibited lower QOL with regard to WHOQOL-BREF-dimensions physical health, psychological, social relationships and global QOL and with regard to WHOQOL-OLD-facets sensory abilities, past, present, and future activities and social participation. In addition, in the regression analysis, there were no significant differences between individuals with and without depression with regard to environment (WHOQOL-BREF), autonomy, death and dying, intimacy and overall (WHOQOL-OLD). Associations between depression and QOL in older age are selective in terms of which aspects of QOL are affected. From a methodological perspective, a multidimensional approach to QOL is recommended. From a clinical perspective, our research highlights those areas of QOL that are relevant for health professionals working with older people and that could be the focus of interventions.

Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace.

BACKGROUND: Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. METHODS: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. RESULTS: Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. CONCLUSIONS: Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

Evaluation of a multidisciplinary concept of mental demands at work on cognitive functioning in old age.

OBJECTIVES: Previous work has shown that high mental demands are associated with better cognitive functioning in old age. As there is a lack of a general conceptual framework for this association, the aim of the study was to investigate how mental demands and other work-related factors relate to cognitive functioning as a foundation for developing such a framework. METHODS: An expert panel discussion was conducted with the aim of determining relevant work-related factors, which were then tested in a survey with 346 employees aged 50+ years, who were actively working. Assessment of cognitive functioning comprised complex attention, executive function, learning/memory, language, perceptual-motor, and social cognition. Confirmatory factor analysis was conducted to confirm factor belonging. Associations with cognitive functioning were analyzed using structure equation modelling to confirm associations and to identify additional direct and indirect paths. RESULTS: Only 42.3% (22/52) of the work-related factors and 19.0% (4/21) of the mediating paths suggested by the experts were significant with respect to cognitive functioning. Factor analysis and structural equation modeling indicated that high mental demands are only associated with better cognitive functioning in old age to the extent that they are intellectually stimulating and this effect is embedded in individual capacities and the social context. CONCLUSION: Based on the panel discussion and the empirical testing, we propose the Conceptual Framework of Social Dependency of Intellectual Stimulation on Cognitive Health. We recommend researchers and workplace health experts to pay attention to the component of this theory when assessing workplace risk.

Development of a protective mental work demands questionnaire.

OBJECTIVES: Research shows that mental demands at work affect later-life cognitive functioning and dementia risk, but systematic assessment of protective mental work demands (PMWDs) is still missing. The goal of this research was to develop a questionnaire to assess PMWDs. DESIGN: The instrument was developed in accordance with internationally recognized scientific standards comprising conceptualization, pretesting, and validation via confirmatory factor analysis (CFA), principal component analysis (PCA), and multiple regression analyses. PARTICIPANTS: We included 346 participants, 72.3% female, with an average age of 56.3 years. MEASUREMENT: Item pool, sociodemographic questions, and cognitive tests: Trail-Making Test A/B, Word List Recall, Verbal Fluency Test, Benton Visual Retention Test, Reading Minds in the Eyes Test. RESULTS: CFAs of eight existing PMWD-concepts revealed weaker fit indices than PCA of the item pool that resulted in five concepts. We computed multivariate regression analyses with all 13 PMWD-concepts as predictors of cognitive functioning. After removing PMWD-concepts that predicted less than two cognitive test scores and excluding others due to overlapping items, the final questionnaire contained four PMWD-concepts: Mental Workload (three items, Cronbach's α = .58), Verbal Demands (four, Cronbach's α = .74), Information Load (six, Cronbach's α = .83), and Extended Job Control (six, Cronbach's α = .83). CONCLUSIONS: The PMWD-Questionnaire intends to assess protective mental demands at the workplace. Information processing demands and job control make up the primary components emphasizing their relevance regarding cognitive health in old age. Long-term follow-up studies will need to validate construct validity with respect to dementia risk.

Mental Demands at the Workplace-Are Information Load, Time Control, and Exploration Associated With Depressiveness?

OBJECTIVE: According to self-determination theory, autonomy and competence are two essential basic human needs. It is the aim of this study to show that mental demands at the workplace (WPMDs) that address those basic needs can protect employees against depressiveness. METHODS: Using a sample of 346 working participants (average age 56.2), we derived three WPMDs (Information Load, Time Control, and Exploration) via principal component analysis. We then analyzed how far they predict depressiveness, and how far this mechanism is mediated by perceived fit between job and person (PJF). RESULTS: Time Control and Exploration significantly reduced depressiveness, and the relationship between exploration and depressiveness was mediated by PJF. CONCLUSIONS: Our results emphasize the importance of addressing basic human needs at the workplace, and the relevance of PJF for employee mental health.

Mild cognitive impairment and quality of life in the oldest old: a closer look.

PURPOSE: Mild cognitive impairment (MCI) is a widespread phenomenon, especially affecting older individuals. We will analyze in how far MCI affects different facets of quality of life (QOL). METHODS: We used a sample of 903 participants (110 with MCI) from the fifth follow-up of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe), a prospective longitudinal study, to analyze the effects of MCI on different facets of the WHOQOL-OLD. We controlled for age, gender, marital status, education, living situation, daily living skills, and the ability to walk, see, and hear. RESULTS: Univariate analyses showed that individuals with MCI exhibited lower QOL with regard to the facets autonomy; past, present, and future activities; social participation; and intimacy, but less fears related to death and dying. No significant difference was shown with regard to the facet sensory abilities. In multivariate analyses controlling for age, gender, marital status, education, living situation, daily living skills, and the ability to walk, see and hear, MCI-status was significantly associated with QOL in the facet autonomy. CONCLUSION: Effects of MCI go beyond cognition and significantly impact the lives of those affected. Further research and practice will benefit from utilizing specific facets of QOL rather than a total score.