Original research
Prevalence and Characteristics of Work Anxiety in Medical Rehabilitation Patients: A Cross-Sectional Observation Study

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Abstract

Objective

To investigate frequency, type, and characteristics of work anxieties in patients with somatic illness.

Design

Cross-sectional observation study.

Setting

Neurology, orthopedic, and cardiology rehabilitation clinics.

Participants

Patients (N=1610; age, 18–65y) with work anxieties.

Interventions

Not applicable.

Main Outcome Measures

Patients who scored high on at least 2 of 9 items in the work-anxiety screening questionnaire and who reported impairment were investigated with a differential diagnostic interview on work anxieties and with the Mini-International Neuropsychiatric Interview on non–work-related common mental disorders. Patients also filled out a self-rating questionnaire on their subjective symptom load and sociodemographic data.

Results

Approximately 20% to 27% of the investigated inpatients in somatic rehabilitation (altogether n=393) received a work-anxiety diagnosis. Patients with orthopedic illness report highest work anxiety and have previous longest sick leave (20.6wk in the past 12mo). Patients with orthopedic illness suffer from work-related adjustment disorder with anxiety, social anxieties, and workplace phobias, whereas patients with cardiac illness are more often affected by hypochondriac anxieties. Anxieties of insufficiency and worrying occur equally in all indications.

Conclusions

About a quarter of patients in somatic rehabilitation are in need of additional diagnostic attention owing to work anxieties. Differential diagnostic of work anxiety is needed for initiating adequate therapeutic action. Somatic rehabilitation physicians should be aware of work anxieties in their patients, especially in patients with orthopedic illness with previous long-term sick leave.

Section snippets

Methods

The study was performed in 3 German somatic rehabilitation clinics, that is, cardiology, orthopedic, and neurology units, between April 1, 2012 and March 31, 2014. Patients with somatic illness are sent to rehabilitation to prevent a chronic course of participation and work ability impairment. The aim is to restore or strengthen work ability and daily life participation. Rehabilitation as inpatient treatment lasts for 3 weeks and covers functional diagnostics, medical, sports, and cognitive and

Results

Table 1 presents the flow of patients over the steps of investigation. Most patients who scored on the work-anxiety screening interview but did not participate in the WAI had from clinical impression sufficient coping, and no clinically relevant work anxiety must be expected (64.4%, n=235+22, Table 1). However, a part must be expected to have serious problems with work anxiety and work avoidance (13.5%, n=17+37, Table 1). These patients could not be investigated further and are thus missing in

Discussion

Epidemiologically it has been found that 22% of patients with cardiac illness suffer from comorbid mental disorders. In a sample of musculoskeletal patients, the prevalence was 28.4%.16 As this present investigation focused on detecting work anxieties, we cannot give epidemiological data on the distribution of general (non–work-related) mental disorders over all initially investigated patients here. But, even more important concerning vocational integration-orientation, we can describe the

Conclusions

Our data show that about a quarter of patients in somatic rehabilitation are in need of additional differential diagnostic attention on work anxieties. To avoid long-term sick leave and deterioration of work-anxiety problems in the long run,24 it makes sense to start speaking about the topic “work” with these patients even parallel to a primarily indicated medical treatment.11

Understanding the differential diagnostic of a work-anxiety problem (ie, is it anxiety of insufficiency due to the

References (25)

  • M. Linden et al.

    Anxiety disorders and workplace-related anxieties

    J Anxiety Disord

    (2007)
  • D. Servant et al.

    [Adjustment disorders with anxiety: clinical and psychometric characteristics in patients consulting a general practitioner]

    Encephale

    (2013)
  • B. Muschalla et al.

    Workplace phobia—a first explorative study on its relation to established anxiety disorders, sick leave, and work-directed treatment

    Psychol Health Med

    (2009)
  • B. Muschalla et al.

    The significance of job-anxiety in a working population

    Occup Med

    (2013)
  • B. Muschalla et al.

    [Work-anxieties and workplace phobia. Phenomenology, diagnostic, therapy, social medicine] [German]

    (2013)
  • M. Linden et al.

    [“Pathological Realangst” in cardiovascular illness] [German].

    Z Psychosom Konsiliarpsychiatrie

    (2008)
  • Diagnostic and statistical manual of mental disorders (DSM-IV)

    (1994)
  • International statistical classification of diseases and related health problems, Tenth revision

    (1992)
  • J. Haines et al.

    Workplace phobia: psychological and psychophysiological mechanisms

    Int J Stress Manage

    (2002)
  • M.E. Smith

    Work phobia and sickness leave certificates

    Afr J Psychiatry

    (2009)
  • R.L. Payne et al.

    An interactionist approach to measuring anxiety at work

    J Occup Psychol

    (1982)
  • B. Muschalla et al.

    Work-anxiety and sickness absence after a short inpatient cognitive behavioral group intervention in comparison to a recreational group meeting

    J Occup Environ Med

    (2016)
  • Cited by (0)

    Supported by the German Pension Fund (grant no. 8011 - 106 - 31/31.107).

    Disclosures: none.

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