Gender effects on outcomes of psychosomatic rehabilitation are reduced

Objective The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men. Methods We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic. Results Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden. Conclusion Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods.

Implementing Digital Trainings within Medical Rehabilitations: Improvement of Mental Health and Synergetic Outcomes with Healthcare Service

The need for new technologies in healthcare services has been stressed. However, little is known about the effectiveness of digital interventions integrated in psychosomatic rehabilitation processes. Data from 724 patients from psychosomatic rehabilitation clinics were analyzed with regard to the effectiveness of digital trainings indicated by a change in symptoms related to depression, anxiety, stress, and loneliness from pre– to post–rehabilitation. Rehabilitation satisfaction was examined in association with reaching rehabilitation goals and satisfaction with communication. A mixed repeated measures analyses of covariance, analyses of covariance, and hierarchical stepwise regression analyses were performed. Results indicated a superior effectiveness for the intervention group receiving all offered digital treatments in addition to the regular face-to-face rehabilitation program with regard to symptoms of depression (F (2674) = 3.93, p < 0.05, ηp2 = 0.01), anxiety (F (2678) = 3.68, p < 0.05, ηp2 = 0.01) post-rehabilitation, with large effect sizes for both depression (d = 1.28) and anxiety (d = 1.08). In addition, rehabilitation satisfaction was positively associated with reaching rehabilitation goals and perceived communication with healthcare workers. Digital interventions appeared effective in supporting mental health of psychosomatic rehabilitation patients’ post-rehabilitation. These findings support the inclusion of multidisciplinary and interdisciplinary digital and face-to-face treatment programs and call for more implementations of new technologies in a context of complexity to improve health and healthcare service.

Treatment Beliefs in Patients with Mental Disorders in Psychosomatic Rehabilitation

Background: The efficacy of inpatient psychosomatic rehabilitation in Germany can be considered proven. However, a significant number of patients with mental disorders remain unsatisfied with rehabilitation or being non-responders. Illness beliefs, as the core element of the Common-Sense Model of Self-Regulation (CSM), are widely known as predictors of various health outcomes. Yet, little is known about treatment beliefs as an extension of the CSM and their impact on health outcomes. Aim: As treatment beliefs differ in relation to the treatment, this study aimed to explore rehabilitation-related treatment beliefs in psychosomatic rehabilitation patients with mental disorders before inpatient admission. Thus, knowledge of the concept of rehabilitation-related treatment beliefs will be added. Methods: N = 10 semi-structured telephone interviews were conducted in September/October 2018. A purposive sampling approach was chosen based on the criteria gender, age, and diagnosis. Participants were asked about their rehabilitation expectations starting with an open narrative question. Interviews were analyzed using qualitative content analysis. Results: Participants had a mean age of 48.3 years ( SD = 9.42); five participants were female and five male. 9 main themes with 32 subthemes as components of the rehabilitation-related treatment beliefs were identified: reasons for rehabilitation, conditions within the clinic, rehabilitation planning, organization of the rehabilitation, the content of the rehabilitation, results of the rehabilitation, concerns, expectations toward one’s behavior, and contact to other patients. Limitation: Our sample was too small to analyze the data for different subgroups. Conclusion: Results show that rehabilitation-related treatment beliefs are multidimensional, addressing different aspects of psychosomatic rehabilitation.

Implemented New Technologies within the Complexity of Medical Rehabilitations: Improvement of Mental Health and Synergetic Outcomes with Healthcare Service Effects

The need for new technologies into healthcare services has been stressed. However, little is known about the effectiveness of digital interventions integrated in psychosomatic rehabilitation processes. Data from 724 patients from psychosomatic rehabilitation clinics were analyzed for effectiveness of digital trainings examined by a change in symptoms related to depression, anxiety, stress and loneliness from pre- to post-rehabilitation. Rehabilitation satisfaction was examined in association with reaching rehabilitation goals and satisfaction with communication. Mixed repeated measures analysis of covariances, analysis of covariances, and hierarchical stepwise regression analyses were performed. Results indicated a superior effectiveness for the intervention group receiving all offered digital treatments in addition to the regular face-to-face rehabilitation program with regard to symptoms of depression, F(2,674)=3.93, p&lt;.05, ηp2=.01), and anxiety, F(2,678)=3.68, p&lt;.05, ηp2=.01), post-rehabilitation with large effect sizes for both depression (d=1.28) and anxiety (d=1.08). In addition, rehabilitation satisfaction was positively associated with reaching rehabilitation goals and perceived communication with healthcare workers. Digital interventions appeared effective in supporting mental health of psychosomatic rehabilitation patients post-rehabilitation. This finding supports the inclusion of multidisciplinary and interdisciplinary digital and face-to-face treatment programs and call for more implementations of new technologies in a context of complexity to improve health and healthcare service.

COVID-19 Pandemic and Mental Health: Digital Trainings to Support Psychosomatic Rehabilitation Patients (Preprint)

BACKGROUND The COVID-19 pandemic has largely affected mental health status and psychological well-being. Especially individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help to cope with these stressors. The internet and digital applications provide a platform to add to regular treatment and to conduct research on this topic. OBJECTIVE Making use of internet-based assessments, this study investigated individuals from the general population and individuals from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19 related worries, and the intention to use common digital applications were compared. Furthermore, we investigated whether partaking in internet-delivered digital trainings prior to and during the rehabilitation stay, as well as the perceived usefulness of digital trainings are associated with improved mental health after rehabilitation. METHODS A large-scale online cross-section study was conducted among the general population (n=1812) in Germany from May 2020 to April 2021. In addition, a longitudinal study was conducted making use of the internet among psychosomatic rehabilitation patients at two measurement timepoints, before (n=1719) and after (n=738) medical rehabilitation, between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and corona-related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariances, exploratory factor analysis, and hierarchical regression analyses were performed. RESULTS Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F(4,2028)=183.74, P<.001, ηp2=.27) compared to the general population. Rehabilitation patients perceived greater satisfaction in communication with healthcare professionals (F(1,837)=31.67, P<.001, ηp2=.04), had lower financial worries (F(1,837)=38.96, P<.001, ηp2=.04), but higher household-related worries (F(1,837)=5.34, P=.02, ηp2=.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower post rehabilitation (F(1,712)=23.21, P<.001, ηp2=.04) than prior to the rehabilitation. Psychosomatic patients reported a greater intention to use common apps and digital trainings (F(3,2021)=51.41, P<.001, ηp2=.07) than the general population. With regard to digital trainings offered prior and during the rehabilitation stay, the perceived usefulness of digital rehabilitation goal trainings was associated with decreased symptoms of depression (ß=-.14, P<.001), anxiety (ß=-.12, P<.001), loneliness (ß=-.18, P<.001) and stress post rehabilitation (ß=-.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F(1,725)=4.82, P=.03, ηp2=.01) and anxiety (F(1,725)=6.22, P=.01, ηp2=.01) from pre to post-rehabilitation. CONCLUSIONS This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the potentials of rehabilitation treatment. Digital rehabilitation components are promising tools that can prepare patients for their rehabilitation stay, integrated well with face-to-face therapy during rehabilitation and support care after rehabilitation.

Work-related medical rehabilitation in patients with mental disorders: the protocol of a randomized controlled trial (WMR-P, DRKS00023175)

Background Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. To ensure that people with a high risk of not returning to work can participate in working life, the model of work-related medical rehabilitation was developed in Germany. The efficacy of these programs in patients with mental disorders has been tested in only a few trials with very specific intervention approaches. To date, there is no clear evidence of the effectiveness of work-related medical rehabilitation implemented in real-care practice. Methods/design Our randomized controlled trial will be conducted in six rehabilitation centers across Germany. Within 15 months, 1800 patients with mental disorders (300 per rehabilitation center) will be recruited and assigned one-to-one either to a work-related medical rehabilitation program or to a conventional psychosomatic rehabilitation program. Participants will be aged 18–60 years. The control group will receive a conventional psychosomatic rehabilitation program without additional work-related components. The intervention group will receive a work-related medical rehabilitation program that contains at least 11 h of work-related treatment modules. Follow-up data will be assessed at the end of the rehabilitation and 3 and 12 months after completing the rehabilitation program. The primary outcome is a stable return to work. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Focus groups and individual interviews supplement our study with qualitative data. Discussion This study will determine the relative effectiveness of a complex and newly implemented work-related rehabilitation strategy for patients with mental disorders. Trial registration German Clinical Trials Register (DRKS00023175, September 29 2020).

Pushing occupational rehabilitation – implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: a survey of therapists and patients

Background Treatment results achieved after fulfilling an inpatient psychosomatic rehabilitation are often not permanent. Additional participation in outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful reentry to working life. A therapy diary should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitates, which could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the evaluation of the effectiveness and implementation potentialities of a therapy diary in outpatient rehabilitation aftercare. Methods In a qualitative study, seven therapists for outpatient rehabilitation aftercare in Central Germany and eleven outpatient psychosomatic rehabilitation patients were interrogated using partially standardized, guideline-based expert interviews. The data evaluation is based on the Qualitative Content Analysis according to Mayring. Results The results show that an accompanying use of a therapy diary during the outpatient rehabilitation aftercare enables an intense commitment through own thoughts and feelings. By writing down thoughts, emotions, dysfunctional behaviors in problematic situations, great successes are experienced. Through this initiated self-reflection process, the rehabilitant gains a better knowledge of one’s behavior in dealing with oneself and the environment and thereby, whenever necessary, learns to create new ways of acting. Conclusions The voluntary use of the therapy diary in the outpatient rehabilitation aftercare could assist the therapy process and henceforward the recovery of the rehabilitants, and also increase the prospect of successful occupational rehabilitation.

Does media use before bedtime affect the sleep of psychosomatic rehabilitation patients?

Objective Media use can affect sleep. However, research regarding various populations is sparse. The objective of this study was to examine the relationship between media use directly before bedtime and various sleep parameters in patients of a psychosomatic rehabilitation clinic. Methods Patients from a German psychosomatic rehabilitation clinic were tested regarding subjective sleep quality and insomnia symptoms based on questionnaires such as the Pittsburgh Sleep Quality Index (PSQI). Eligible patients also completed an additional sleep log over a period of 1 week. A total of 347 insomnia patients were enrolled, with a mean age of 49.77 years (range 22–64 years; median = 52 years). 57.5% of the patients were 50 years or older. Results Analysis showed that media use and various sleep diary parameters such as total sleep time (r = −0.386, p = 0.042; rTST2 = 0.149) and sleep efficiency (r = −0.507, p = 0.006; rSE2 = 0.257) were significantly associated. In detail, more media consumption was associated with less total sleep time and a lower sleep efficiency. The same result was found for media use and sleep efficiency on weekdays (r = −0.544, p = 0.002; rSE2 = 0.296), but not for other sleep parameters. However, media use time and subjective sleep quality were not significantly correlated, r = −0.055, p = 0.768. Conclusion This study, which is the first to examine the relation between media use and sleep in patients of a psychosomatic rehabilitation clinic, suggests a significant association between media use and sleep duration as well as sleep efficiency. However, more research is needed to investigate the relationship between media use and sleep in more detail, to increase patients’ quality of life and to incorporate these findings into the daily life of clinicians and therapists as well as into sleep hygiene education and sleep trainings.

Pushing occupational rehabilitation – Implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: A survey of therapists and patients.

Background Treatment results achieved after completion of inpatient psychosomatic rehabilitation are often not permanent. Further participation in an outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful return to working life. A therapy diary, should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitants, could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the assessment of the effectiveness and implementation possibilities of a therapy diary in outpatient rehabilitation aftercare. Methods Seven group leaders in Central Germany and eleven psychiatric rehabilitants were interviewed in a qualitative study using partially standardized, guideline-based expert interviews. The data evaluation is based on the Qualitative Content Analysis according to Mayring. Results The results indicate that the accompanying use of a therapy diary within the outpatient rehabilitation aftercare, the rehabilitated by writing down thoughts, emotions, dysfunctional behaviours in problematic situations and thereby experienced successes, allows an intense engagement with their own thoughts and feelings. Through this initiated self-reflection process, the rehabilitant gains a better understanding of one's own behaviour in dealing with oneself and the environment and thereby learns to generate new ways of acting if necessary. Conclusions The use of the therapy diary on a voluntary basis in the outpatient rehabilitation aftercare could support the therapy process and thus the recovery of the rehabilitants and also increase the chance of a successful occupational rehabilitation.