Diagnostische Verfahren zum beruflichen Belastungs- und Bewältigungserleben in der psychosomatischen Rehabilitation

Abstract

Psychosomatic rehabilitation research increasingly agrees that symptom-related therapies need to be supplemented by work-related therapeutic interventions. However, there is a lack of evaluated diagnostic instruments for determination of an indication for and evaluation of specific work-related interventions. This article presents an analysis of the diagnostic quality of work-related self-rating instruments as well as their evaluation from a practical perspective. 281 psychosomatic inpatients showing high levels of occupational stress were studied using a set of work-related questionnaires on admission: individual coping skills (AVEM), work-related therapy motivation (FBTM), work satisfaction (ABB), leisure activities, experienced control at work, as well as occupational concerns and social stressors at work. Furthermore a sub-group of 78 patients who had completed a specific work-related group programme during their inpatient treatment were interviewed three months post-treatment. The instruments used were examined for reliability, underlying dimensions (factor analysis), health relevance (correlations with the SCL-90-R total score GSI as health-related external criterion), and sensitivity to change. (1) Reliability: Measuring procedures fulfilled the requirements of measurement accuracy. (2) Underlying dimensions: Factor-analytical investigations of relevant occupational constructs identified six aspects of occupational coping relevant for rehabilitation practice: "occupational resilience", "occupational (over-)commitment", "occupational gratification", "well-being at work", a motivational factor of "occupational identification vs. withdrawal", and "leisure activities". (3) Health relevance: Variables of "occupational resilience" and "occupational gratification" showed the highest correlations with indicators of psychosomatic health. (4) Sensitivity to change: Work-related instruments proved to be predominantly sensitive to change. The work-related self-report instruments proved satisfactorily in application with psychosomatic patients. The findings concerning their diagnostic quality show that they can be recommended in research to evaluate work-related issues. Longitudinal evaluations should include work-related diagnostic instruments to a much larger extent.