[Pilot study examining a profession-oriented rehabilitation concept for nursing professions]. / Pilotstudie zur Evaluation einer medizinisch-beruflich orientierten Rehabilitation für Pflegekräfte.

Pilot study examining a profession-oriented rehabilitation concept for nursing professions Objectives: Nursing professions are associated with high levels of psychological distress, high numbers of absent days and premature retirement. To achieve higher return-to-work rates, psychosomatic rehabilitation is expected to offer treatments tailored to workplace demands. This pilot study is the first to examine the effects of a new workplace-oriented medical rehabilitation program for nursing professions. Methods: A total of N = 145 depressed patients in nursing occupations (86.9 % female; 50.9 ± 7.34 years) took part in a workplace-oriented rehabilitation program for nursing professions. At admission they were compared to N = 147 depressed patients (63.27 % female; 49.36 ± 7.58 years) in non-nursing professions regarding patterns of work-related experience and behaviour (AVEM) using a MANOVA with follow-up ANOVAs for individual subscales. Changes in work-related attitudes among the nursing professions following completion of the intervention were assessed using a MANOVA followed by repeated measures ANOVAs. The effect of the workplace- oriented intervention on depressiveness (BDI-II) was compared to a treatment program for depression using a mixed model after taking potentially confounding variables into account. Results: At entry, depressed patients in nursing professions scored significantly higher on AVEM scale willingness to work to exhaustion and lower on AVEM scale distancing ability compared to depressed patients in other professions. Following completion of the workplace-oriented intervention program for nursing professions, participants showed a significant reduction on AVEM scales subjective importance of work, willingness to work to exhaustion, and striving for perfection. Increasing scores were observed on the distancing ability and life satisfaction scales. Depression scores had significantly improved at discharge in both participants of the work-oriented intervention and the disorder-specific intervention for depressive disorders, whereas neither group differences nor interaction effects were found. Conclusions: The work-oriented intervention for nursing professions successfully induced changes in maladaptive work-related attitudes. Improvements in depressiveness did not significantly differ from an intervention targeting depression specifically.

[Changes of Motor Balance in the Course of an Inpatient Psychosomatic Rehabilitation]. / Veränderung motorischer Gleichgewichtsfähigkeit im Verlauf einer stationären psychosomatischen Rehabilitationsmaßnahme.

Aim of the study For many rehabilitants both the motor balance and the feeling of being emotionally stable and in balance are essential preconditions for participation in employment and society. The goal of this study was to capture changes in motor balance in the course of an inpatient psychosomatic rehabilitation and to set them in relation to changes in mental variables. Methods 118 patients of a psychosomatic clinic (49.3±8.6 years; 75.4 % women) were examined at the beginning and the end of rehabilitation. To measure motor balance the balance test (GGT) of Bös, Wydra and Karisch, the timed up and go test (TUG), eight tasks of standing balance on an unstable surface as well as eight tasks on a stable surface were used. As psychological variables, self-esteem (MSWS), degree of depressive (BDI-II) and anxiety symptoms (BAI) were measured. Results The motor balance ability, assessed by the GGT (d=1,37), the TUG (d=0,56), tasks of standing balance on an unstable surface (d=1,48) as well as on a stable surface (d=0.67), increased significantly in the course of rehabilitation and was also reflected in the self-evaluation of motor balance (d=0,97). Correlations in the change of motor and mental variables were particularly evident between the balance tasks on an unstable and a stable surface and different scales of the MSWS. Conclusion In the course of rehabilitation, an improvement in psychological symptoms as well as the balance ability was found, however, contrary to our expectations, no significant correlations were observed. At the first view it seems like there would be no relationship between psychological factors and the motor balance of the patients. However it should be noted that motor balance was examined in a standardized situation in which the patients were not exposed to any particular psychological distress. Observations during the conduct of the study suggest that changes in motor balance could be shown rather in observable characteristics of postural control (for example in contraction and relaxation) than in the number of fulfilled tasks. The motor balance tests were not only accepted very well by the rehabilitants but often also provoked self-reflection processes on topics such as balance and stability in a psychosomatic sense. Further research both on the factors influencing the motor balance ability as well as on their relation to the improvement in activity and participation appears promising.

Responsivity and relation to depressive symptoms of occupational behavior and experience patterns.

Introduction: Work stress is a frequent factor in the development of depression. However, not only workplace environment, but also personal attitudes may affect stress experience. The aim of this study was to investigate the change sensitivity of occupational attitudes in psychosomatic inpatients and assess the relationship of changes to depressive symptom reduction. Methods: The data set encompassed N = 1708 inpatients from two German psychosomatic rehabilitation clinics at admission and discharge. Responsivity of AVEM measures was evaluated by Bonferroni-corrected t-tests and Cohen's dz effect sizes for paired samples. The relation of occupational behavior and experience patterns and depressive symptoms as assessed by the BDI-II questionnaire was calculated by Pearson correlation analysis of pre-post differential values. Results: Changes in work attitudes were found on eight out of eleven AVEM subscales (Padj ≤ 0.001, Cohen's dz = -0.45 to 0.43) and all AVEM coping styles. Most patients (57.4%) were classified to have a Burnout occupational coping style at admission. Changes following rehabilitation were most frequently observed from Burnout to Sparing coping styles (8.3%). Small to moderate associations between changes in occupational attitudes and depressive symptom reduction were found for all subscales (r = -0.39 to 0.25) except work ambition, and for occupational coping styles Burnout (r = 0.19), Sparing (r = -0.18) and Healthy (r = -0.10), but not Ambitious. Discussion: The data support responsivity of occupational behavior and experience patterns within a psychosomatic rehabilitation setting. Correlations with depressive symptom reduction suggest that occupational attitudes are related but separate treatment targets.

Development and Psychometric Properties of the Test of Passive Aggression.

Background: To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior. Method: Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N = 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N = 180). Results: In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio = 1.98; RMSR = 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α = 0.83-0.90) and 4-week retest-reliability (r tt = 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA. Conclusions: The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior.

Pre-rehabilitation sense of coherence as a predictor of symptom change after rehabilitation.

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong cross-sectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings. The goal of the current study was to address this gap. The sample of the two-wave longitudinal study consists of 294 patients receiving inpatient psychotherapeutic (and psychopharmacological) treatment for various psychological disorders at a German psychosomatic rehabilitation clinic. SOC (Antonovsky, Social Science & Medicine, 1993, 36, 725-733) and outcome measures (i.e., general mental health problems, depression and anxiety symptoms) were assessed within two days of arrival and at the end of rehabilitation (week 5/6). SOC was significantly enhanced after treatment whereas psychopathological symptoms were significantly reduced. Regression analyses revealed that pre-treatment SOC was a significant negative predictor of post-treatment symptom severity for all outcome measures even after controlling for pre-treatment symptoms. The current findings provide first evidence that SOC is a significant unique predictor of symptom change. Future studies need to further investigate longitudinal associations between SOC and mental health outcomes in different settings.