The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study.

OBJECTIVE: The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1. METHODS: In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2). RESULTS: The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician. CONCLUSION: The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.

Correlations of the "Work-Family Conflict" With Occupational Stress-A Cross-Sectional Study Among University Employees.

Background: The working conditions at universities and hospitals are reported to be stressful. Several national and international studies have investigated occupational stress in hospitals. However, scientific studies at colleges and universities addressing psycho-social stress factors and their potential consequences are scarce. In this context, the consequences and correlations of the factor of work-family conflict, in particular, are currently uninvestigated. The aim of our study was to assess data on psychosocial stress in the context of the compatibility of work and family. Methods: Data were gathered through a cross-sectional-study, N = 844 (55% female, 41% male), on university staff (42.3% scientists, 14.3% physicians, 19.4% employees in administration, and 19.3% employees in service). Participants filled out questionnaires to provide their personal data and details of their work and private life conditions. For this purpose, we used the Work-Family and Family-Work Conflict Scales, Effort-Reward Inventory and Overcommitment Scale (ERI, OC), Patient Health Questionnaire (PHQ-4), short-form Maslach Burnout Inventory (MBI), and questions on their subjective health. Statistical analyses were performed using SPSS 22. Results: We found high levels of stress parameters in the total sample: extra work (83%), fixed-term work contracts (53%), overcommitment (OC, 26%), Effort-Reward Imbalance (18%, ERI Ratio > cut-off 0.715), work-family conflict (WFC, 35%), and family-work conflict (FWC, 39%). As hypothesized, we found significant correlations of both WFC and FWC with psychosocial work strain (ERI Ratio) as well as overcommitment (OC). Mental and somatic health parameters also had a significant positive correlation with WFC and FWC. Using a regression analysis (N = 844), we identified WFC as a predictor of burnout, while emotional exhaustion, extra work, and overcommitment could be identified as predictors of WFC and FWC. Discussion: The results of our study point toward deficits in the compatibility of work life and private life in the work fields of science, colleges, and universities. Furthermore, we found indicators that work-family conflicts (interrole conflicts) have an impact on mental and somatic health. These work-family conflicts should be targets for preventions and interventions with the aim of improving the work-life balance and mental and somatic wellbeing of employees.

[Mental health among physicians : Burnout, depression, anxiety and substance abuse in the occupational context]. / Psychische Gesundheit von Ärzten : Burnout, Depression, Angst und Substanzgebrauch im Kontext des Arztberufes.

The prevalence rates of psychiatric disorders show a high risk for psychological impairment among physicians in Germany. There is evidence that the mental health of physicians exerts a significant influence on the quality of patient care. The estimated prevalence rates for burnout among physicians in Germany vary between 4% and 20% and for depression between 6% and 13%. In addition, there is evidence for impairment in the context of anxiety, suicidal tendencies and substance abuse. Importantly, work-related stress factors play an important role in the development of mental disorders among physicians. In addition to individual prevention and interventions, institutional measures have been shown to be effective as a preventive strategy. It is therefore important to establish effective interventions specifically tailored to physicians to reduce stress factors at work.

Head movements and postures as pain behavior.

Pain assessment can benefit from observation of pain behaviors, such as guarding or facial expression, and observational pain scales are widely used in clinical practice with nonverbal patients. However, little is known about head movements and postures in the context of pain. In this regard, we analyze videos of three publically available datasets. The BioVid dataset was recorded with healthy participants subjected to painful heat stimuli. In the BP4D dataset, healthy participants performed a cold-pressor test and several other tasks (meant to elicit emotion). The UNBC dataset videos show shoulder pain patients during range-of-motion tests to their affected and unaffected limbs. In all videos, participants were sitting in an upright position. We studied head movements and postures that occurred during the painful and control trials by measuring head orientation from video over time, followed by analyzing posture and movement summary statistics and occurrence frequencies of typical postures and movements. We found significant differences between pain and control trials with analyses of variance and binomial tests. In BioVid and BP4D, pain was accompanied by head movements and postures that tend to be oriented downwards or towards the pain site. We also found differences in movement range and speed in all three datasets. The results suggest that head movements and postures should be considered for pain assessment and research. As additional pain indicators, they possibly might improve pain management whenever behavior is assessed, especially in nonverbal individuals such as infants or patients with dementia. However, in advance more research is needed to identify specific head movements and postures in pain patients.

Recognition of Intensive Valence and Arousal Affective States via Facial Electromyographic Activity in Young and Senior Adults.

BACKGROUND: Research suggests that interaction between humans and digital environments characterizes a form of companionship in addition to technical convenience. To this effect, humans have attempted to design computer systems able to demonstrably empathize with the human affective experience. Facial electromyography (EMG) is one such technique enabling machines to access to human affective states. Numerous studies have investigated the effects of valence emotions on facial EMG activity captured over the corrugator supercilii (frowning muscle) and zygomaticus major (smiling muscle). The arousal emotion, specifically, has not received much research attention, however. In the present study, we sought to identify intensive valence and arousal affective states via facial EMG activity. METHODS: Ten blocks of affective pictures were separated into five categories: neutral valence/low arousal (0VLA), positive valence/high arousal (PVHA), negative valence/high arousal (NVHA), positive valence/low arousal (PVLA), and negative valence/low arousal (NVLA), and the ability of each to elicit corresponding valence and arousal affective states was investigated at length. One hundred and thirteen participants were subjected to these stimuli and provided facial EMG. A set of 16 features based on the amplitude, frequency, predictability, and variability of signals was defined and classified using a support vector machine (SVM). RESULTS: We observed highly accurate classification rates based on the combined corrugator and zygomaticus EMG, ranging from 75.69% to 100.00% for the baseline and five affective states (0VLA, PVHA, PVLA, NVHA, and NVLA) in all individuals. There were significant differences in classification rate accuracy between senior and young adults, but there was no significant difference between female and male participants. CONCLUSION: Our research provides robust evidences for recognition of intensive valence and arousal affective states in young and senior adults. These findings contribute to the successful future application of facial EMG for identifying user affective states in human machine interaction (HMI) or companion robotic systems (CRS).

The complex duration perception of emotional faces: effects of face direction.

The perceived duration of emotional face stimuli strongly depends on the expressed emotion. But, emotional faces also differ regarding a number of other features like gaze, face direction, or sex. Usually, these features have been controlled by only using pictures of female models with straight gaze and face direction. Doi and Shinohara (2009) reported that an overestimation of angry faces could only be found when the model's gaze was oriented toward the observer. We aimed at replicating this effect for face direction. Moreover, we explored the effect of face direction on the duration perception sad faces. Controlling for the sex of the face model and the participant, female and male participants rated the duration of neutral, angry, and sad face stimuli of both sexes photographed from different perspectives in a bisection task. In line with current findings, we report a significant overestimation of angry compared to neutral face stimuli that was modulated by face direction. Moreover, the perceived duration of sad face stimuli did not differ from that of neutral faces and was not influenced by face direction. Furthermore, we found that faces of the opposite sex appeared to last longer than those of the same sex. This outcome is discussed with regards to stimulus parameters like the induced arousal, social relevance, and an evolutionary context.

Automatic pain quantification using autonomic parameters

The objective measurement of subjective, multi-dimensionally experienced pain is a problem for which there has not been an adequate solution. Although verbal methods (e.g., pain scales and questionnaires) are commonly used to measure clinical pain, they tend to lack objectivity, reliability, or validity when applied to mentally impaired individuals. Biopotential and behavioral parameters may represent a solution. Such coding systems already exist, but they are either very costly or time-consuming or have not been sufficiently evaluated. In this context, we collected a database of biopotentials to advance an automated pain recognition system, determine its theoretical testing quality, and optimize its performance. For this purpose, participants were subjected to painful heat stimuli under controlled conditions. One hundred thirty-five features were extracted from the mathematical groupings of amplitude, frequency, stationarity, entropy, linearity, and variability. The following features were chosen as the most selective: (1) electromyography corrugator peak to peak, (2) corrugator shannon entropy, and (3) heart rate variability slope RR. Individual-specific calibration allows the adjustment of feature patterns, resulting in significantly more accurate pain detection rates. The objective measurement of pain in patients will provide valuable information for the clinical team, which may aid the objective assessment of treatment (e.g., effectiveness of drugs for pain reduction, information on surgical indication, and quality of care provided to patients).(AU)

Automatic pain quantification using autonomic parameters

The objective measurement of subjective, multi-dimensionally experienced pain is a problem for which there has not been an adequate solution. Although verbal methods (e.g., pain scales and questionnaires) are commonly used to measure clinical pain, they tend to lack objectivity, reliability, or validity when applied to mentally impaired individuals. Biopotential and behavioral parameters may represent a solution. Such coding systems already exist, but they are either very costly or time-consuming or have not been sufficiently evaluated. In this context, we collected a database of biopotentials to advance an automated pain recognition system, determine its theoretical testing quality, and optimize its performance. For this purpose, participants were subjected to painful heat stimuli under controlled conditions. One hundred thirty-five features were extracted from the mathematical groupings of amplitude, frequency, stationarity, entropy, linearity, and variability. The following features were chosen as the most selective: (1) electromyography corrugator peak to peak, (2) corrugator shannon entropy, and (3) heart rate variability slope RR. Individual-specific calibration allows the adjustment of feature patterns, resulting in significantly more accurate pain detection rates. The objective measurement of pain in patients will provide valuable information for the clinical team, which may aid the objective assessment of treatment (e.g., effectiveness of drugs for pain reduction, information on surgical indication, and quality of care provided to patients).

An investigation of facial emotion recognition impairments in alexithymia and its neural correlates.

Alexithymia is a personality trait that involves difficulties identifying emotions and describing feelings. It is hypothesized that this includes facial emotion recognition but limited knowledge exists about possible neural correlates of this assumed deficit. We hence tested thirty-seven healthy subjects with either a relatively high or low degree of alexithymia (HDA versus LDA), who performed in a reliable and standardized test of facial emotion recognition (FEEL, Facially Expressed Emotion Labeling) in the functional MRI. LDA subjects had significantly better emotion recognition scores and showed relatively more activity in several brain areas associated with alexithymia and emotional awareness (anterior cingulate cortex), and the extended system of facial perception concerned with aspects of social communication and emotion (amygdala, insula, striatum). Additionally, LDA subjects had more activity in the visual area of social perception (posterior part of the superior temporal sulcus) and the inferior frontal cortex. HDA subjects, on the other hand, exhibited greater activity in the superior parietal lobule. With differences in behaviour and brain responses between two groups of otherwise healthy subjects, our results indirectly support recent conceptualizations and epidemiological data, that alexithymia is a dimensional personality trait apparent in clinically healthy subjects rather than a categorical diagnosis only applicable to clinical populations.

Normal emotion regulation in adults with cleft lip and palate: an exploratory study.

INTRODUCTION: Cleft lip and palate (CLP) represent the most common congenital malformations of the midfacial region. Although these patients show differences in their facial appearance, we hypothesize that CLP-affected individuals do not show an alteration in their emotion regulation abilities compared to unaffected individuals. This is because of the strong biological basis of facial emotion and expression that is inherent and receives little influence from external factors. MATERIAL AND METHODS: The present study evaluated various aspects of emotion regulation in 25 adults with CLP and an equally sized control group of unaffected volunteers. The study was divided into three parts. First, we investigated emotion regulation strategies. Here, each participant was asked to complete the Emotion Regulation Questionnaire (ERQ) and Ambivalence over Emotional Expressiveness Questionnaire G 18 (AEQ-G18). Second, we examined the recognition of facially expressed basic emotions (FEEL test). Third, we evaluated the expression of an emotion induced by an odor sample. RESULTS: Habitual emotion regulation, measured by ERQ and AEQ-G18, was not different between CLP and controls subjects for all of the sub-scales. Recognition of facially expressed basic emotions was also the same for both groups. Facial emotion encoding did not differ for both groups. CONCLUSIONS: To summarize, the findings suggest that individuals with an orofacial cleft show undisturbed emotion regulation and recognition. This may be explained by the strong biological basis of facial emotion recognition and regulation as well as by the healthy emotional resilience and social functioning of CLP patients.

Emotional ambivalence and post-traumatic stress disorder (PTSD) in soldiers during military operations.

OBJECTIVE: This pilot study examined the extent to which a specific mechanism of emotion regulation - namely, ambivalence concerning the expressiveness of German soldiers' emotions - affects the severity of PTSD symptoms after a military operation. METHODOLOGY: A survey was conducted at three points in time among 66 soldiers deployed on military crisis operations. The Harvard Trauma Questionaire (HTQ), the Ambivalence over Emotional Expressiveness Questionnaire (AEQ-G18), and a questionnaire on the particular stress of German soldiers during military operations were used. RESULTS: The study showed a significant correlation between emotional ambivalence and traumatization. Furthermore, it was shown that the subjective stress of soldiers leading up to deployment is more pronounced when emotional ambivalence is stronger in the context of military operations. This particular stress is greater before and during the military operation than after. Compared to a male control sample, the average AEQ-G18 scores of the soldier sample examined here are considerably lower. CONCLUSION: This pilot study clearly indicates that the AEQ-G18 could be a suitable predictor of the psychological burden on soldiers. The correlations between emotional ambivalence on the one hand and the particular and post-traumatic stressors on the other hand are not only statistically significant in the present pilot study, but may also be relevant as risk factors. It is, therefore, necessary to conduct more extensive studies on soldiers participating in military operations to verify the results of this pilot study.

The effect of forced choice on facial emotion recognition: a comparison to open verbal classification of emotion labels.

OBJECTIVE: This article includes the examination of potential methodological problems of the application of a forced choice response format in facial emotion recognition. METHODOLOGY: 33 subjects were presented with validated facial stimuli. The task was to make a decision about which emotion was shown. In addition, the subjective certainty concerning the decision was recorded. RESULTS: The detection rates are 68% for fear, 81% for sadness, 85% for anger, 87% for surprise, 88% for disgust, and 94% for happiness, and are thus well above the random probability. CONCLUSION: This study refutes the concern that the use of forced choice formats may not adequately reflect actual recognition performance. The use of standardized tests to examine emotion recognition ability leads to valid results and can be used in different contexts. For example, the images presented here appear suitable for diagnosing deficits in emotion recognition in the context of psychological disorders and for mapping treatment progress.