Zusammenhänge zwischen der Soziallage, Empowermentprozessen und der Entwicklung psychischer Gesundheit

Abstract

The aim of this paper is to deepen our knowledge about empirical evidence of empowerment on the basis of follow-up data from mother-child rehabilitation centres. The study focusses on three questions: i) to what extent can psychological health in different socioeconomic groups be improved by the intervention?, ii) Is there an impact of social position on the success of empowerment and iii) Is there any relevance of empowerment for sustainable improvement of psychological health? The study is based on data from 6 095 patients of 39 mother-child rehabilitation centres in Germany, collected up to one year after intervention. Empowerment was assessed by two self-defined scales, measuring positive changes i) in living circumstances, such as partnership or household ('Verhältnis-Empowerment') and ii) in health-related behaviours and competencies, such as better coping with problems and higher health awareness ('Verhaltens-Empowerment'). Health status was assessed by psychological symptoms and measured by SCL-K-9, a short form of the SCL-90-R. The socioeconomic position was determined by cluster analysis, the influence of social position and empowerment for psychological health was computed by analysis of regression. Before intervention mothers from the lower class showed higher degrees of psychological symptoms. After intervention they reached higher short-term effects, but six months later psychological symptoms increased again. In particular improvement of health-related behaviours and competencies was associated with better psychological health. The highest impact on health was found among mothers from the middle and lower class. These mothers, however, showed less success in optimising health-related behaviours and competencies. Twelve months after treatment the health-related impact of empowerment decreased. The theoretical evidence of empowerment could be empirically confirmed. However, decreasing health effects of empowerment after twelve months show that supporting help after clinical intervention is necessary to maintain the positive impact of empowerment. Only small differences in empowerment between lower and middle class lead to the conclusion that terms of social class are less appropriate for the clinical sample of mothers investigated in this study.