Unveiling social relationships: exploring the importance of relationships as a moderator of the link between effort-reward imbalance and leader-member exchange among healthcare professionals.

OBJECTIVE: Healthcare professionals are at increased risk of experiencing occupational stress and its detrimental stress-sequalae. Relevant theories that contribute to the subjective experience of occupational stress have been identified, such as the model of effort-reward imbalance (ERI) and the concept of leader-member exchange (LMX). The aim of this study was to examine how the perceived importance of social relationships at work moderates the relationship between LMX and imbalance ERI. METHODS: A survey was conducted among N = 1,137 healthcare professionals from diverse occupational categories in a tertiary hospital in Germany. ERI was gauged using the German version of the Effort-Reward Imbalance Questionnaire (ERI-S 10). The quality of leader-employee dyadic relationships was assessed using the German version of the Leader-Member Exchange (LMX-7). The importance of social relationships was assessed on the basis of a previously validated polarity profile. RESULTS: More than 75% of healthcare professionals reported high levels of ERI, with those involved in direct patient care particularly affected. On average, leaders rated relationship quality higher than their respective followers. Subjectively higher LMX was associated with lower ERI. This association was moderated by the perceived importance of social relationships at work. Higher subjective ratings of their importance led to a stronger association. CONCLUSION: The study highlights the particular challenges faced in the healthcare sector. The results emphasize that the perceived importance of social relationships at work can play a key role in healthcare professionals' job stress and underline the need for stress prevention programs that engage both leaders and followers.

[Effects of complex trauma disorder on the workplace: a scoping review]. / Auswirkungen der komplexen Traumafolgestörung auf die Arbeitswelt: Ein Scoping-Review.

BACKGROUND: The "International Classification of Diseases 11th Revision" (ICD-11) introduces complex post-traumatic stress disorder (CPTSD) as a separate diagnosis to account for the effects that persistent or repetitive trauma can have. In CPTSD, disorders of self-organization are added to the core symptoms of PTSD. It can be assumed that those affected are impaired in their professional lives as a result. The aim of this paper is to provide an overview of the effects of CPTSD on work-related functioning and to present possible consequences for therapeutic and rehabilitative treatment. METHOD: A scoping review with a literature search in the MEDLINE, APA PsycArticles, and APA PsycInfo databases was conducted in February 2024. RESULTS: Of 2378 studies on KPTBS, five studies were included, of which only three dealt more specifically with the impact on the world of work. Those affected appear to have a poorer prognosis for maintaining their ability to work and are therefore to be regarded as a socio-medical risk group with regard to long-term maintenance of participation in working life. DISCUSSION: The current state of research on the effects of the CPTSD symptom complex on the world of work is surprisingly limited. In comparison, the results indicate that CPTSD has a greater negative impact on the ability to function in the world of work than PTSD and other mental disorders. It is still unclear which psychopathological mechanisms mediate the connection. Only basic findings on the psychopathology of CPTSD are available. Treatment approaches that address the disorders of self-organization in addition to PTSD symptoms appear necessary.

[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.

[Psychotherapeutic consultation at work: associations between company size and psychosomatic health]. / Psychotherapeutische Sprechstunde am Arbeitsplatz: Zusammenhänge zwischen Unternehmensgröße und psychosomatischer Gesundheit.

BACKGROUND: The utilization of psychotherapeutic consultation at work (PT-A) has so far been investigated in large enterprises (LEs). These differ structurally from small(est) and medium-sized enterprises (SMEs). Differences in the user profiles of a PT­A with regard to psychosomatic health, work-related self-efficacy, and work ability depending on company size have hardly been investigated. This study also examined differences in the employees' perception of the psychosocial safety climate (PSC) in the company, which represents management's efforts to promote mental health. METHODS: As part of the Early Intervention in the Workplace intervention study called "friaa", employees from LEs and SMEs interested in a PT­A were surveyed throughout Germany from September 2021 to January 2023. Using t­ and χ2-tests, differences between employees in LEs (n = 439) and SMEs (n = 109) were examined with regard to the ICD-10 F diagnostic code ("International Statistical Classification of Diseases and Related Health Problems"; mental and behavioral disorders), depression (PHQ-9), anxiety (GAD-2), level of functioning (GAF), somatic symptom burden (SSS-8), health (VR-12), ability to work (WAI), self-efficacy (SOSES), and psychosocial safety climate (PSC-4). The association between these variables and especially the PSC­4 were investigated using correlation analysis. RESULTS: Both groups showed similar levels of stress. From the employees' perspective, psychosocial issues were addressed significantly more frequently in LEs than in SMEs with a medium effect size. The study provided initial indications that in LEs there were positive correlations of the PSC­4 with SOSES and WAI and negative ones with PHQ­9 and SSS­8. DISCUSSION: The comparable psychological strain on employees in LEs and SMEs points to the need for behavioral and structural preventive measures regardless of the company size. Mainly in SMEs, organizational communication of psychosocial health should be given greater priority.

[Mental health in the workplace - What role do socioeconomic-, gender-, and migration-related inequalities play?] / Psychische Gesundheit am Arbeitsplatz ­ Welche Rolle spielen sozioökonomische, geschlechterspezifische und migrationsbedingte Ungleichheiten?

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 (M = 13.0, SD = 5.1) (PHQ-9 ≥ 10), anxiety (M = 3.5, SD = 1.7) (GAD ≥ 3) and somatization (M = 13.0, SD = 5.8) (SSS-8 ≥ 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.

[Rationale, models, and impact of workplace-based psychotherapeutic services]. / Rationale, Modelle und Wirkung arbeitsplatznaher psychotherapeutischer Angebote.

Mental illnesses and behavioral disorders are very common among the working population, affecting up to a third of employees each year, and are associated with great suffering, the risk of chronicity, and the loss of employment. Economically, mental illnesses cause high costs. In order to mitigate these consequences and increase the chances of recovery, rapid diagnosis, early and appropriate treatment where necessary, and-over and above the usual psychotherapy approach-attention to the work-related causes are of crucial importance.Psychotherapeutic Consultation at the Workplace (PT-A) attempts to meet these requirements. It offers psychotherapeutic help at short notice and close to the workplace for employees suffering from mental stress; provides (depending on the problem) counseling, diagnostics, prevention, and short-term or bridging therapy; and supports reintegration after a longer period of mental illness. It is helpful to cooperate closely with the company medical service, which consults the PT­A, refers employees to it, provides information on the company situation, and can support reintegration if necessary. Funding is often provided by the company but can also be provided by health insurance companies in integrated care models.This article begins by describing the history and principles of PT­A and the role of work stress in the development of psychological and psychosomatic disorders. The implementation of PT­A is then outlined using two examples. Finally, the current study "Early Intervention at the Workplace" ("Frühe Intervention am Arbeitsplatz" [friaa]), to which several articles in this special issue refer, is briefly presented.

Working conditions and mental health of migrants and refugees in Europe considering cultural origin- a systematic review.

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.

Words count in psychotherapy: Differentiating language characteristics of cognitive behavioral therapy and focal psychodynamic therapy for anorexia nervosa.

It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Smartphone and Instagram use, body dissatisfaction, and eating disorders: investigating the associations using self-report and tracked data.

BACKGROUND: Previous research has linked smartphone and Instagram use to higher body dissatisfaction (BD) as well as eating disorder (ED) symptomatology. However, these studies have typically been limited to using self-report measures for technology use which, as shown by scientific literature, might not be reliable. In the present work, we combine self-reported assessments as well as tracked smartphone and Instagram use. METHODS: The effective sample comprised N = 119 women (34 with ED diagnosis history) who were queried about BD and ED symptomatology, and who provided the data about their smartphone and Instagram use duration for each day of the previous week. RESULTS: The study results show that women with an ED diagnosis history scored higher on both BD as well as ED scales. Although women with an ED diagnosis history had higher smartphone screen time, there were no statistically significant differences in Instagram screen time. Tracked smartphone use duration was positively correlated with both BD and ED symptomatology, but the role of Instagram use needs to be further elucidated. CONCLUSIONS: The results of this study show that while BD and ED symptomatology are correlated with smartphone use, it may be that Instagram use is not the main contributor to that relationship.

The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa.

Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.

Heart rate variability predicts outcome of short-term psychotherapy at the workplace.

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

Occupational physicians dealing with mental health: between employee and company interests: a qualitative study.

BACKGROUND: Occupational health physicians are increasingly confronted with mental health issues at their workplace. Facing them, most of them feel insecure and not sufficiently trained. Employee's mental well-being depends at the same time on individual and significantly on organizational variables. This complicates the physician's position, since they have to serve many interests. The focus of the present study is to investigate what difficulties occupational health physicians face and how organizational culture and management influence their work. METHODS: Interviews were conducted with N = 25 physicians as part of a training for basic mental health care. Interviews were interpreted using qualitative content analysis. RESULTS: Working with mentally ill employees was difficult for the physicians interviewed. Many felt insecure managing and preventing mental health issues. A need for further education was observed. Environmental factors (organizational culture, management) have a strong impact on the work of an occupational health physician and highlight its systemic dimension. Even though many of our participants report a meanwhile more open attitude towards mental disorders at their workplace, on the level of direct contact to the management prevail descriptions of little acceptance and a high priority of economic outcomes. CONCLUSIONS: More education on topics of mental health is needed for occupational health physicians. Future trainings should consider the intertwined nature of their work and enable them in dealing consciously with other actors in the company. For enhancing employee's mental well-being occupational health physicians could be granted a strengthened position in companies or be supported through more exchange with colleagues in other companies.

The association of perceived leadership style and subjective well-being of employees in a tertiary hospital in Germany.

BACKGROUND: Professionals in the healthcare sector are a particularly vulnerable group for occupational strain due to high work-related psychological stress. For the implementation of targeted stress-prevention interventions as an important part of a workplace health management programme for all occupational groups and hierarchy levels, information about the current state of their mental health is mandatory. Hence, this study investigated the association of general well-being and different leadership styles among employees in a German tertiary hospital. METHODS: Via an online survey, 10,101 employees were contacted. The final sample consisted of 1137 employees. Of these, 27.7% described themselves as leaders and 72.3% as followers. Most participants were female (74.8%), more than half were under 41 years old. Besides control variables, general well-being (WHO-5) and leadership style (transactional and transformational, laissez-faire and destructive leadership) were assessed. RESULTS: Leaders reported higher well-being scores than followers. Physicians without leadership responsibilities had the lowest scores for well-being. Practitioners of both transformational and transactional leadership were associated with higher well-being scores, while those practicing laissez-faire and destructive leadership had lower scores for almost every professional group. CONCLUSION: Results highlight the necessity for future multimodal health-preventive leadership interventions feature behavioural and organizational intervention modules specifically tailored to hospital professionals at different hierarchical and functional levels to foster the mental health of employees.

Conceptual Framework of a Psychotherapeutic Consultation in the Workplace: A Qualitative Study.

(1) Background: A new health care offer called 'psychotherapeutic consultation in the workplace' is an early and effective intervention for employees with common mental disorders. Although cost-effective, it lacks a broader roll-out. This might be attributable to undefined context, mechanisms of change, and a lack of communication; therefore, this study explores how the new model works and where problems occur. (2) Methods: Semi-structured interviews on motivation, expectations and experiences with 20 involved experts. Experts were members of the company health promotion team, service users, and cooperating mental health specialists. Analysis was conducted with ATLAS.ti. (3) Results: The conceptual framework comprises three main topics: (a) structured implementation concept; (b) persons involved, shaping the concept's processes; (c) and meaning and function of the offer within the given context. Concerning (c) we found three potential areas of conflict: (1) intra-corporate conflicts, (2) conflicts between company and employee, (3) and conflicts between the company health promotion and the health care system. Category (c) comprises the offer's core characteristics which were described as low-threshold and preventive. Furthermore, the offer was perceived as convenient in handling, confidential, and having immediate impact on a person's well-being. (4) Conclusions: Here we define structures, address the needs of the involved persons, and communicate foreseeable areas of conflict influences whether the implementation of the intervention succeeds.

Evaluation of measurement properties of the German Work Role Functioning Questionnaire.

OBJECTIVE: We assessed the measurement properties of the German Work Role Functioning Questionnaire (WRFQ) after its cross-cultural adaptation of the Dutch version. The WRFQ is a generic role-specific instrument that measures how a particular health status influences the ability to meet work demands. METHODS: We performed an observational study among German employees assessing the following measurement properties: 1) structural, 2) convergent and 3) discriminant validity, 4) floor and ceiling effects, 5) internal consistency, 6) reproducibility and 7) responsiveness. Participants were recruited from an online access panel sample aged 18 to 64 years having worked more than 12 hours in the last 4 weeks prior to study enrollment (n(T0) = 653, n(T1) = 66, n(T2) = 95). RESULTS: Measurement properties proved to be good except for structural validity and responsiveness. An exploratory factor analysis showed limited replicability of three of the four original subscales. CONCLUSION: With the WRFQ German version, the extent can be measured, to which employees with a certain health level experience problems can meet their work demands. This widely used health-related work outcome measurement tool, that helps to identify employees with decreasing work functioning, is now also available in German. This gives researchers and practitioners the opportunity to address work functioning in practice, e.g. in intervention studies in occupational health or rehabilitation. Further research to examine valid subscales is needed.

Group-Treatment for Dealing with the Work-Family Conflict for Healthcare Professionals.

Healthcare professionals' exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals.

[Providing Rapid Help for Mental Strain at the Workplace: Psychosomatic Consultation in the Workplace]. / Rasche Hilfe bei psychischen Belastungen am Arbeitsplatz: Die Psychosomatische Sprechstunde im Betrieb.

BACKGROUND: Psychosomatic consultation in the workplace (PSIW) is an offer for employees who are under mental and psychosomatic strain. Core elements are early diagnosis and short-term psychotherapy with the aim of improving the care for mentally stressed employees. This article provides a characterization of patients and presents initial data on the effects of short-term psychotherapy. MATERIALS AND METHODS: From 05/2016 to 12/2019, basic data were collected from all employees seeking help. Socio-demographic data, previous treatments, work ability, depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), assessment of psychological state and attitudes towards treatment options were collected by self-report before and (if applicable) after a short-term intervention. RESULTS: A total of 672 employees from 20 companies (49% male) were mostly referred to PSIW by the company physician. Adjustment disorders and depressive disorders each accounted for almost one-third of diagnoses. A quarter of the employees presenting at PSIW were on sick leave at the time of referral. The most frequent recommendations were short-term intervention at PSIW, followed by outpatient psychotherapy. A total of 343 (51%) employees completed the questionnaires, of which 187 (55%) of them received short-term psychotherapy. The symptoms improved significantly across all scales. Satisfaction with PSIW was very high. CONCLUSIONS: PSIW is an innovative care concept in the work context, which is well accepted and effective in various sectors. Close cooperation with company stakeholders such as occupational health physicians is important for a successful outcome.

Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project).

BACKGROUND: Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. METHODS: This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. DISCUSSION: Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. TRIAL REGISTRATION: The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049 .

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees.

Background: Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression). Objective: There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics. Methods: The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models. Results: The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended. Discussion and Conclusions: The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.