[Effects of complex trauma disorder on the workplace: a scoping review]. / Auswirkungen der komplexen Traumafolgestörung auf die Arbeitswelt: Ein Scoping-Review.

BACKGROUND: The "International Classification of Diseases 11th Revision" (ICD-11) introduces complex post-traumatic stress disorder (CPTSD) as a separate diagnosis to account for the effects that persistent or repetitive trauma can have. In CPTSD, disorders of self-organization are added to the core symptoms of PTSD. It can be assumed that those affected are impaired in their professional lives as a result. The aim of this paper is to provide an overview of the effects of CPTSD on work-related functioning and to present possible consequences for therapeutic and rehabilitative treatment. METHOD: A scoping review with a literature search in the MEDLINE, APA PsycArticles, and APA PsycInfo databases was conducted in February 2024. RESULTS: Of 2378 studies on KPTBS, five studies were included, of which only three dealt more specifically with the impact on the world of work. Those affected appear to have a poorer prognosis for maintaining their ability to work and are therefore to be regarded as a socio-medical risk group with regard to long-term maintenance of participation in working life. DISCUSSION: The current state of research on the effects of the CPTSD symptom complex on the world of work is surprisingly limited. In comparison, the results indicate that CPTSD has a greater negative impact on the ability to function in the world of work than PTSD and other mental disorders. It is still unclear which psychopathological mechanisms mediate the connection. Only basic findings on the psychopathology of CPTSD are available. Treatment approaches that address the disorders of self-organization in addition to PTSD symptoms appear necessary.

Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project).

BACKGROUND: Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. METHODS: This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. DISCUSSION: Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. TRIAL REGISTRATION: The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049 .

[Complex Posttraumatic Disorder and Work-Related Behavioral and Experience Patterns]. / Komplexe Posttraumatische Belastungsstörung und arbeitsbezogene Verhaltens- und Erlebensmuster.

OBJECTIVE: This study examined differences in work-related behavioral and experiential patterns between patients with positive screening for complex PTSD (CPTSD), patients with positive screening for PTSD and patients with negative screening for trauma sequelae. METHODS: Participants were 566 patients (mean age 50.96 +/- 8.73 years; 70.3 % female) of a psychosomatic rehabilitation clinic. Self-reported screening instruments were administered to participants at the beginning of their inpatient psychotherapy. Univariate analyses of variance were used to assess group differences in work-related experience- and behavioral patterns. The instrument identifies 11 dimensions of health-promoting or -endangering behavior and experiences in coping with work and occupational demands. RESULTS: On 8 of 11 work-related dimensions, significant differences were found between the groups "without PTSD" and "CPTSD". The "PTSD" and "CPTSD" groups differed significantly on the dimensions of "resignation tendencies", "offensive coping" and "life satisfaction". The groups "without PTSD" and "PTSD" did not differ significantly. DISCUSSION: Patients with a positive CPTSD screening represent a particularly burdened patient group in the working context. They reported problematic behavior and experience patterns that correspond to the problem areas of self-organization described in the diagnostic criteria of the ICD-11. CONCLUSION: This suggests that for patients with CPTSD special interventions within the context of medical-professional oriented rehabilitation are useful to compensate these deficits and maintain participation in working life.

The effects of a short-term physician training on smoking cessation in a university pulmonary department.

Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians' performance of smoking cessation interventions. The effects on patients' cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians' application of "Ask" (OR 3.28, 95% CI 1.13-9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24-5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on "Assist" (OR 2.05, 95% CI 1.09-3.87). No significant effect was seen on "Advise to quit". Physicians overestimated their intervention frequencies and reported the patients' low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.

Symptom burden and work-related impairment among patients with PTSD and complex PTSD.

Background: The 11th revision of the International Classification of Diseases includes a new chapter of stress-related disorders and presents two distinct sibling conditions: Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Studies show that PTSD and CPTSD are associated with different levels of symptom burden, comorbidity and functional impairment, but have not yet addressed the qualitative and quantitative differences in work-related impairment between the two diagnoses. Objective: The aim of this study was to replicate differences in symptom severity, global distress, and the number of comorbid diagnoses between three groups that suffer from no PTSD, PTSD, or CPTSD. More importantly, we evaluated whether the three groups differ in indicators of functional impairment such as qualitative and quantitative working capacity. Finally, this study supplies information on prevalence rates of PTSD and CPTSD in a clinical sample suffering from psychosomatic complaints. Methods: Participants were 662 patients of a Psychosomatic Rehabilitation Clinic (age M = 50.99, SD 8.99 years; 70.1% female). Self-report screening instruments were administered to participants at the beginning of their inpatient psychotherapy. Multivariate analysis of variance and Chi Square tests were utilized to assess group differences in symptom severity, comorbidity and work-related impairment. Results: A prevalence of 13.3% CPTSD and 9.5% PTSD was found among the current sample. CPTSD was associated with heightened symptom burden and more comorbid diagnoses. More importantly, CPTSD was associated with a significantly lowered qualitative and quantitative working capacity compared to PTSD and no-PTSD. Conclusions: The high prevalence, greater psychopathological burden and work-related impairments in CPTSD compared to PTSD highlight the need for developing and evaluating new interventions in rehabilitation that address the complexity of the new disorder.

Antecedentes: la décimaprimera revisión de la Clasificación Internacional de Enfermedades incluye un nuevo capítulo de trastornos relacionados con estrés y presenta dos condiciones distintas hermanas: trastorno de estrés postraumático (TEPT) y TEPT complejo (TEPT-C). Los estudios muestran que el TEPT y el TEPT-C están asociados con diferentes niveles de carga de síntomas, comorbilidad y deterioro funcional, pero aún no han abordado las diferencias cualitativas y cuantitativas en el deterioro relacionado con el trabajo entre los dos diagnósticos.Objetivo: El objetivo de este estudio fue replicar las diferencias en la gravedad de los síntomas, la angustia global y el número de diagnósticos comórbidos entre tres grupos, sin TEPT, con TEPT y con TEPT-C. Más importante aún, evaluamos si los tres grupos difieren en los indicadores de deterioro funcional, como la capacidad de trabajo cualitativa y cuantitativa. Finalmente, este estudio proporciona información sobre las tasas de prevalencia de TEPT y TEPT en una muestra clínica que padece molestias psicosomáticas.Método: los participantes fueron 662 pacientes de una clínica de rehabilitación psicosomática (edad M = 50.99, SD 8.99 años; 70.1% mujeres). Los instrumentos de detección por auto-reporte se administraron a los participantes al comienzo de su psicoterapia hospitalaria. Se utilizó análisis multivariado de la varianza y pruebas de Chi cuadrado para evaluar las diferencias grupales en la gravedad de los síntomas, la comorbilidad y la discapacidad relacionada con el trabajo.Resultados: Se encontró una prevalencia de 13.3% de TEPT-C y 9.5% de TEPT entre la muestra actual. El TEPT-C se asoció con una mayor carga de síntomas y más diagnósticos comórbidos. Más importante aún, el TEPT-C se asoció con una capacidad de trabajo cualitativa y cuantitativa significativamente reducida en comparación con TEPT y no TEPT.Conclusiones: la alta prevalencia, la mayor carga psicopatológica y las deficiencias relacionadas con el trabajo en el TEPT-C en comparación con el TEPT destacan la necesidad de desarrollar y evaluar nuevas intervenciones en rehabilitación que aborden la complejidad del nuevo trastorno.