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Common mental disorders (CMDs) are risk factors for long-term sickness absence and unemployment. Therefore, return-to-work (RTW) processes have been introduced to facilitate the return of employees. As the success of RTW processes is considered to be determined by the cooperativeness of the involved stakeholders, we aimed to investigate the views of those stakeholders to disclose potentially diverging expectations. Qualitative interviews were conducted (08/2018-04/2019) among five stakeholder groups: returnees with a diagnosed CMD who were eligible for a RTW process, health care professionals nominated by the returnees, supervisors, colleagues and occupational physicians (the latter three groups were not nominated by the returnees). In total, 24 returnees, 13 health care professionals, 13 occupational physicians, 9 supervisors and 9 colleagues were interviewed (68 interviews in total). Potentially diverging expectations of the stakeholders related to whether diagnoses need to be disclosed by returnees. Agreement existed in terms of the need for a trustful relationship between employees and occupational physicians to initiate a RTW process early. As the understanding of all stakeholders&rsquo, viewpoints is one of the main factors promoting a successful RTW, we explored the expectations of those involved in the RTW process. One implication of our findings is to strengthen the role of occupational physicians, who could coordinate the return process.

Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002&ndash, 2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56&ndash, 0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30&ndash, 2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09&ndash, 1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12&ndash, 2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.

The HeiDE study (‘‘Heidelberger Langzeitstudie zu Risikofaktoren und Diagnose chronischer Erkrankungen’’) is a longitudinal population-based study that started in the 1990s and, at baseline, assessed an array of health-related personality questionnaires in 5 133 individuals. Five latent personality dimensions (The Heidelberg Five) were identified and interpreted as Emotional Lability (ELAB), Lack of Behavioral Control (LBCN), Type A Behavior (TYAB), Locus of Control over Disease (LOCC), and Psychoticism (PSYC). A subset of participants (n=3 268; after quality control) were genotyped on whole-genome arrays at follow-up. To further characterize The Heidelberg Five, we analyzed genomic underpinnings, their relations to the genetic basis of the Big Five trait Neuroticism, and longitudinal associations with lifetime psychiatric symptoms. SNP-based heritability was significant for ELAB (34%) and LBCN (29%). Five separate genome-wide association studies (GWAS) using factor scores on personality dimensions as phenotypes were conducted, only the phenotype PSYC yielded a genome-wide significant finding (p−8, top SNP rs138223660). Gene-based analyses identified significant findings for ELAB (Integrin Subunit Beta 5), TYAB (Coiled-coil Domain Containing 83), and PSYC (Nuclear Receptor Subfamily 1 Group H Member 4). Polygenic risk scores for Neuroticism, phenotypically related to ELAB, were associated with ELAB, but not with the remaining Heidelberg Five. Longitudinally, all personality dimensions were related to depressive symptoms at follow-up, with ELAB, LBCN, and PSYC also associated with lifetime anxiety symptoms. These results highlight the clinical importance of health-related personality traits, and identify LBCN as a heritable “executive function” personality trait.

This study set out to explore the effects of accumulating work experience on the association between job decision latitude and its interaction with job demands and work engagement. Our ten-year lon...

BACKGROUND: Previous research suggests that psychosocial working conditions may detrimentally affect diabetes self-management behavior at work, including self-monitoring of glucose levels. We aimed to better understand the potential usefulness of continuous glucose monitoring devices at the workplace according to employees with diabetes. METHODS: We carried out secondary analyses of data from a qualitative study, which sought to explore potential barriers to and solutions for effective diabetes self-management at work. Interviews were carried out in face-to-face contact or by telephone and were transcribed and content-analyzed using MaxQDA. The used topic guide did not specifically inquire after continuous glucose monitoring devices, but views on the suitability of those devices at the workplace repeatedly emerged from the interviews. Data from 25 employed adults with diabetes mellitus type 1 or type 2 on insulin therapy were included. RESULTS: The major perceived improvements associated with the use of continuous glucose monitoring devices pertained to their time-saving application that allowed for an increased frequency of glucose level assessments and for socially covert glucose measurement. The socially less noticeable way of monitoring glucose level was specifically perceived as beneficial, as employees with diabetes believed their illness would thereby attract less attention. Fewer or shorter interruptions as well as the reliability of integrated alarm systems were perceived to increase concentration at work and workability. CONCLUSIONS: Continuous glucose monitoring devices were perceived to facilitate glucose management at the workplace, which may exert positive effects on compliance as well as functioning at work. Further research would be of interest to statistically confirm our findings in occupational samples.

Aims We conducted a qualitative study to expand our current understanding of the potential link between psychosocial working conditions and diabetes self-management at work. Methods Thirty employed adults with diabetes mellitus living in Germany (n = 19 with type 1, n = 11 with type 2, 57% female, aged 24–64 years) were recruited. Using a topic guide, we carried out in-depth interviews in face-to-face contact or by telephone. Interviews were transcribed and content-analyzed using MaxQDA. Results Psychosocial working conditions perceived to detrimentally affect self-management activities included, amongst others, a high workload, poor job control, unhygienic working environments, the requirement to work under high or fluctuating temperature, perceived social norms at the workplace, and the attitude to prioritize work-related demands as opposed to diabetes-related demands. The types of self-management activities considered to be adversely affected related to glucose monitoring, insulin injections, dietary control, the ability to recognize hypoglycemia and health care use. Conclusions Various types of occupational psychosocial factors may determine diabetes self-management practices at the workplace. Quantitative studies are needed to confirm our observations. Subsequently, interventions could be developed and evaluated to improve opportunities to adequately engage into diabetes self-management at work.

Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though. We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort–reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses. The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one’s current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22). Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.

Objective: To explore effects of the implementation of clinical pathways (CPs) on hierarchical structures within a surgical department. Summary of background data: CPs are care plans stipulating diagnostic and therapeutic measures along a time axis for a given condition or procedure. They are widely used in surgery. There is limited evidence to what extent CP implementation has an effect on hierarchical structures within surgical departments. Methods: Semistructured individual interviews were conducted with key members of a CP project team in a large academic surgery department. Interviews were carried out by an external researcher to increase the likelihood of obtaining unbiased opinions. Using an interview guide, it was ensured that respondents provided opinions on various issues related to CP implementation, including hierarchical relationships within the department, but also between caregivers and patients. The transcribed text was independently content analyzed by 2 researchers who converged their findings. Results: Clinical pathway implementation changed perceived surgical hierarchy from a top-down to a participatory approach. However, it was acknowledged that some form of hierarchy is required to ensure successful clinical pathway implementation. Respondents felt that clinical pathways changed surgical culture from a largely eminence-based to more evidence-based medicine. Conclusions: The implementation of CPs potentially affects several dimensions of surgical hierarchy. It changes “traditional” surgical hierarchy and is associated with perception of increased autonomy and competency in junior staff. The clinical approach appears to shift from eminence- to evidence-based medicine. The knowledge about these changes is important for carrying out CP projects in surgery.

There is ample evidence supporting the link between stress at the workplace and physical and mental health. One of the pathways potentially mediating those associations may involve the hypothalamic-pituitary-adrenal (HPA) axis, with cortisol as an end product. While theoretically plausible, findings on the association of self-reported work stress with hair cortisol concentrations (HCC) are inconclusive, being potentially biased by omitted pertinent factors. This issue can be addressed, among others, by eliminating time-invariant factors through consideration of variation within persons over time. To this end, the present study examined the association between variation in HCC and perceived work stress − as assessed by the Effort-Reward-Imbalance (ERI) model − between two points in time (t1 and t2) over one year in a sample of 40 male factory workers. Neither a cross-sectional association, nor a link between change in ERI and HCC levels at t2 was observed. There was however a robust association of the change in ERI with the change of HCC. This effect was independent of baseline HCC and other confounders (Beta = 0.414, S.E. = 0.155, p = 0.012). Accordingly, this is the first study revealing prospective evidence for the associations of work stress with HCC, while excluding potentially time-stable confounding factors, like genetic factors or phenotypic hair color.

AimEpidemiological studies from high‐income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle‐ and low‐income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes–social impairment link in low‐, middle‐ and high‐income countries. MethodsWe use data from the cross‐sectional World Health Survey (n = 235 428 from 10 low‐income, 29 middle‐income and 9 high‐income countries). Diabetes was defined by self‐reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health‐related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility). ResultsIn the overall sample, we confirmed an association between self‐reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18–1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low‐income countries = 2.23, 95% CI = 1.14–4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72–1.16) and all income regions. ConclusionsSelf‐reported diabetes is associated with impaired social functioning in high‐ and middle‐income countries, and this relationship is even stronger in low‐income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.

University dropout is often preceded by a phase of doubt whether to continue studying, either in general or just the given subject. Mental health problems might be interrelated with this phase of doubt. Counselling services at German universities could provide help, but do not seem to reach students in need. To explore the phase of doubt and possible (inter-)relationships with mental wellbeing among university students in Germany as well as their consultation-seeking behaviour, a qualitative interview study was conducted (2017–2018). Participants were students casting doubts on their studies (n = 14) and counsellors (n = 16) working with this target group. Examples of reasons for doubts were insufficient information, unfulfilled expectations concerning the subject, subjectively poor study conditions, performance problems, and lacking future perspectives. Mental health problems were subjectively intertwined with doubts, considered as both cause and effect. Counselling services were evaluated as hardly helpful by students and as being in need of improvement by counsellors. Suggestions as how to improve such services comprise a more specific and proactive way to approach students. By considering the phase of doubt before dropout, German universities can improve their support services to be more responsive to students and, thus, prevent dropout and mental health problems.

Objective Epidemiological evidence suggests that work stress is associated with suicidal ideation (SI). However, only few studies in this area have drawn on well-established theoretical work stress models (i.e., the job-demand-control [JDC] model, the effort-reward-imbalance [ERI] model, and the model of organizational injustice [OJ]). Utilization of such models allows though for theory-based assessments and workplace interventions. Since evidence on those models' relationship with suicide-related outcomes is currently inconclusive (with regard to JDC), markedly sparse (OJ) or lacking (ERI), we aimed to provide additional or initial evidence. Methods We drew on original data from six cross-sectional studies, which were conducted in four countries (i.e., South Korea, China, Australia, and Germany). Work stress was measured by established questionnaires and was categorized into tertiles. In each study, SI was assessed by either one or two items taken from validated scales. Associations of work stress with SI were estimated for each study and were pooled across studies using multivariate random-effects logistic modeling. Results In the pooled analyses ( n = 12,422) all three work stress models were significantly associated with SI with odds ratios fluctuating around 2. For instance, the pooled odds ratios for highest versus lowest work stress exposure in terms of job strain, OJ, and ERI equalled 1.91 (95% confidence interval [CI] = 1.52, 2.41), 1.98 (95% CI = 1.48, 2.65), and 2.77 (95% CI = 1.57, 4.88), respectively. Patterns of associations were largely consistent across the individual studies. Conclusion Our study provides robust evidence of a positive association between work stress and SI.

Adverse psychosocial working conditions in the health care sector are widespread and have been associated with a reduced quality of patient care. Medical assistants (MA) assume that their unfavorable working conditions predominantly lead to a poorer quality of care in terms of slips and lapses, and poorer social interactions with patients. We examined those associations for the first time among MAs. A total of 944 MAs in Germany participated in a survey (September 2016–April 2017). Psychosocial working conditions were measured by the effort-reward imbalance (ERI) questionnaire and a questionnaire specifically designed for MAs. Slips and lapses (3 items, e.g., measurement or documentation errors) and the quality of interactions (3 items) with patients were measured by a questionnaire developed by the study team based on prior qualitative research. We ran Poisson regression to estimate multivariable prevalence ratios (PRs). The ERI ratio and MA-specific working conditions were significantly associated with frequent self-reported slips and lapses (PR = 2.53 and PR ≥ 1.22, respectively) or poor interactions with patients (PR = 3.62 and PR ≥ 1.38, respectively) due to work stress. Our study suggests that various types of adverse psychosocial working conditions are associated with perceptions of slips and lapses or poorer interaction with patients due to work stress among MAs.