[Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?] / Mediiert die schmerzspezifische Selbstwirksamkeit die Beziehung zwischen Depressivität und arbeitsbezogenen Faktoren bei nichtspezifischen chronischen Rückenschmerzen?

BACKGROUND: The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy. OBJECTIVE: Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms? METHODS: Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP. RESULTS: The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship. CONCLUSION: To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.

[Debora: Long-Term Effectiveness of an Inpatient Combined Pain Competence and Depression Prevention Training for Non-Specific Chronic Low Back Pain and Depressive Symptoms]. / Debora: Langfristige Wirksamkeit eines stationären störungsspezifischen Schmerzkompetenz- und Depressionspräventionstrainings bei chronisch unspezifischem Rückenschmerz und Depressivität.

OBJECTIVE: To investigate the effects of an intervention for pain competence and depression prevention for multidisciplinary inpatient rehabilitation of non-specific chronic low back pain on psychological and work-related outcomes over a 2-year period. METHODS: This prospective randomized controlled multicenter trial evaluated the effects of pain competence training with and without depression prevention on depressive symptoms (General Depression Scale; ADS; primary outcome), anxiety (Hospital Anxiety and Depression Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire) and subjective prognosis of gainful employment (SPE; secondary outcomes) in n=422 patients aged 32-64 years from four rehabilitation clinics. Per protocol analyses were conducted. In the three-factorial design with a repeated-measures factor, patients were stratified by treatment condition; the control group (CG) received only pain management training but the intervention group (IG) was additionally treated with depression prevention training (Debora). Based on the ADS, patients were assigned to without or low depressive symptoms (ADS<23; n=208) and medium or high depressive symptoms (ADS≥23; n=214). The fivefold repeated-measures factor included the following sample points: admission, immediately after and 6, 12, and 24 months after rehabilitation. Per protocol results of univariate 2×2×5 analyses of variance were validated by n=1225 multiple imputed data. RESULTS: No significant effects of treatment condition over the 2-year period were yielded in the primary outcome "depressive symptoms", but only patients with the combined training Debora benefited in pain self-efficacy in the long term. Intention-to-treat analyses suggest incremental effects of Debora on pain self-efficacy and anxiety at 24-month follow-up. In the long term, patients with high levels of depressive symptoms improved exclusively in depressive symptoms or they benefited more than patients with low depression in anxiety. However, favorable effects receded in general from post rehabilitation to 24-month follow-up. DISCUSSION: The results support that a disorder-specific depression prevention training is needed for the long-term improvement in pain self-efficacy, which is considered a crucial psychological protective factor in pain chronification. Findings on depressive symptoms support the effectiveness of multidisciplinary inpatient rehabilitation in high depression, but also the great importance of early treatment of depressive symptoms. CONCLUSION: Overall, the results strengthen the need to implement psychotherapeutic treatment elements and, in particular, cognitive-behavioral methods and, moreover, a systematic allocation of patients to needs-based treatments in order to improve long-term effects.

Long-term effects of rehabilitation and prevention of further chronification of pain among patients with non-specific low back pain.

BACKGROUND: Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success. OBJECTIVE: To examine the effects of a combined pain competence and depression prevention training compared to the pain competence training alone and as well as the patients' stages of pain on the long-term psychosocial rehabilitation success. METHODS: In this controlled multicentre study with cluster-block randomization, patients with CLBP in different stages of pain (I-III) received either pain competence training (control group, CG; n= 255) or combined pain competence and depression prevention training (intervention group, IG; n= 271; per protocol). Depressive symptoms (primary outcome), anxiety, somatization, health status, and average pain intensity (secondary outcomes) were assessed up to 12 months of follow-up. Standardised questionnaires were used to record the outcomes, which were filled out by the patients themselves. Analyses after multiple imputation (N= 1225) were conducted to validate multi- and univariate analyses of variance. RESULTS: Patients in stage of pain I and II showed significant improvements in depressive symptoms, anxiety, mental health, and average pain intensity at the 12-month follow-up, irrespective from treatment condition. CONCLUSIONS: Multidisciplinary rehabilitation seems to be appropriate for patients with CLBP in stage of pain I and II. However, patients in stage of pain III need more psychological treatments to manage their mental comorbidities.

Police Officers' Ability in Recognizing Relevant Mental Health Conditions.

The recognition of certain mental health conditions is important as this requires police officers to communicate and behave in an adjusted manner with affected individuals. The objective of the present study was to test police officers' knowledge about mental health symptoms as a component of their mental health literacy (MHL) and to examine if police officers' perceived knowledge corresponds with their actual knowledge. A questionnaire was used to assess for MHL representing mental health conditions which occur frequently in police requests (schizophrenia, bipolar disorder, depression, post-traumatic stress disorders, and emotionally unstable personality disorder). Furthermore, the questionnaire assessed the frequency of police requests, the officers' perceived knowledge regarding mental disorders and their sense of feeling sufficiently trained to deal with these kinds of requests. Eighty-two police officers participated in the study. Police officers' actual knowledge about mental health conditions did not correspond with their perceived knowledge. Participants revealed a moderately high level of overall knowledge which differed with regard to symptoms of each of the five mental health conditions. The mental status of a paranoid schizophrenia was best identified by the police officers and the majority correctly allocated the symptoms. Post-traumatic stress disorders and manic episodes were only identified by a minority of police offers. Police training geared to prepare for requests involving individuals with mental disorders should expand this limited knowledge transfer and focus on a broader variety of mental health conditions that police officers frequently encounter in requests.

Mediating Effects of Mental Health Problems in a Clinical Sample of Adolescents with Obesity.

INTRODUCTION: The prevalence rates of obesity have increased in recent decades; despite leveling off in recent German studies among children and adolescents, obesity rates remain high. Psychosocial factors have an adverse impact on the maintenance of obesity. Hence, this study examined the mediating effects of mental health problems on the relation between the body mass index standard deviation score (BMI-SDS) and global health-related quality of life (HRQoL) among adolescent inpatients with obesity while controlling for gender and age-group. METHODS: Three simple mediation analyses with gender and age-group as covariates were conducted for n = 313 adolescents with obesity (nfemale = 193, 61.7%) aged 12-17 (M = 14.19, SD = 1.52; BMI-SDS: M = 2.67, SD = 0.52). The adolescents were asked to report their global HRQoL at admission, and their parents estimated the children's mental health problems at home prior to inpatient rehabilitation. RESULTS: Emotional, peer-related, and conduct problems mediated the unfavorable effects of BMI-SDS on global HRQoL, showing high, moderate, and small effect sizes, respectively (completely standardized indirect effect of emotional problems: ß = -0.09, SE = 0.03, 95% B-CI = -0.15 to -0.04; conduct problems: ß = -0.03, SE = 0.02, 95% B-CI = -0.06 to -0.01; peer-related problems: ß = -0.10, SE = 0.03, 95% B-CI = -0.16 to -0.05). CONCLUSION: Mental health problems may be one salient pathway through which BMI-SDS impairs global HRQoL among adolescents with obesity. Hence, inpatient rehabilitation programs for adolescents with obesity should increase their focus more on the development of psychosocial skills. Thus, the promotion of emotion regulation and social-emotional competencies is suggested.

[Influence of Social Status on the Success of Rehabilitation among Patients with Chronic Low Back Pain - Results of a 2-year Follow-up after Inpatient Multidisciplinary Rehabilitation]. / Der Einfluss der sozialen Lage auf den Rehabilitationserfolg von Rehabilitanden mit chronischem Rückenschmerz.

PURPOSE: Social inequality in medical rehabilitation is receiving increasing attention. The present study examined the impact of the social status on the long-term effectiveness of the pain competence and depression prevention training "Debora" among patients with chronic low back pain (CLBP) in an inpatient multidisciplinary rehabilitation. METHODS: The control group study with cluster-block randomization investigated the long-term changes in pain self-efficacy, psychological burden, functional capacity, and subjective work ability among 394 patients with non-specific CLBP depending on the condition (control group, CG: pain competence training vs. intervention group, IG: additional depression prevention training) and the social status (lower, middle vs. upper class; according to Deck [1]). The data were collected at five sample points: pre (t0), post (t1), 6-(t2), 12-(t3) and 24-month follow-up (t4). Multi- or univariate repeated-measures analyses of variance were conducted per protocol (pp). In a second step, results should be confirmed by multiple imputations (MI; N=1089). RESULTS: In general, patients of the lower class showed significantly worse values in depressive symptoms, functional capacity, and subjective work ability compared to the upper class. In addition, positive long-term effects could not be found among patients of the lower class. In contrast, patients of the middle and upper class improved, especially in the IG. Furthermore, only the IG showed long-term improvements in subjective work capacity. CONCLUSION: This study confirms the influence of the social status on the psychophysical health. Moreover, social inequality in long-term success of rehabilitation of CLBP was suggested, which could be mediated by health literacy. Therefore, these aspects should be taken into account already in the conception and especially in the application of psychological group trainings in inpatient rehabilitation.

[Validity of the Mainz Pain Staging System for chronic low back pain : A cross-sectional analysis of inpatient multidisciplinary rehabilitation]. / Validität des Mainzer Stadienmodells bei Rückenschmerzen : Eine Querschnittsanalyse in der stationären verhaltensmedizinisch orthopädischen Rehabilitation.

BACKGROUND: Psychological factors have an influence on the manifestation as well as on the maintenance of chronic low back pain (CLBP) and are increasingly considered in research. OBJECTIVES: The present study investigated the validity and clinical relevance of the Mainz Pain Staging System (MPSS) to replicate previous study results in the setting of inpatient multidisciplinary orthopedic rehabilitation (MOR). METHODS: In this multicenter study, psychological and pain-related parameters were investigated among 1012 patients with nonspecific CLBP (ICD-10: M51/53/54) at the beginning of an inpatient MOR stratified according to the stage of pain in the MPSS (I-III). In addition, frequency distributions of scores in the clinical range for depression, anxiety, somatization, and pain-related self-efficacy were determined as a function of pain chronification. RESULTS: Stage of pain had a significant effect on all psychological and pain-related parameters in the expected direction. Alongside patients with stage III, patients with stage II showed higher levels of impairment regarding psychological factors. Furthermore, patients with stage III often had higher clinical scores than expected for depression, anxiety, and somatization. CONCLUSION: These results confirm the validity and clinical relevance of the MPSS. Moreover, the psychological burden of the patients increased with the stage of pain. Therefore, psychological treatments are required that are tailored to patients' needs. Thus, measurement of the MPSS and psychological diagnostic assessments are recommended.

[Debora: Acceptance and Feasibility of Pain Competence and Depression Prevention Training in Multidisciplinary Inpatient Rehabilitation]. / Debora: Akzeptanz und Machbarkeit eines Schmerzkompetenz- und Depressionspräventionstrainings in der VMO.

There is an increasing need for patient education in chronic low back pain with mental comorbidity. The present study was carried out in the setting of multidisciplinary inpatient rehabilitation and investigated the acceptance and feasibility of the Debora pain competence and depression prevention training comparing an intervention group with a control group. While patients of the intervention group took part in the pain competence and depression prevention training, patients of the control group only participated in pain competence training. METHOD: A total of 3 partial studies were used for formative evaluation. The triangulative design consisted of problem-centered interviews and focus groups with rehabilitation patients as well as focus groups with experts. The interviews were transcribed, anonymized, and content analysis was performed. RESULTS: The training was well accepted and feasible from the perspective of the patients and experts. The therapists had a significant influence on the participants' satisfaction. Suggestions for improvement focused on developing extensions of the pain and stress management aspects and on discussing individual problems. Compared to the intervention group and independent of depression, the control group assessed the training as being less satisfatory and showed poor group coherence. CONCLUSIONS: Results of the formal evaluation support the combined implementation of the Debora pain competence and depression prevention training program and suggest its long-term establishment in multidisciplinary inpatient rehabilitation.

[Psychological Measures and BMI-SDS among Adolescents with Obesity and Different Motivational Stages in Inpatient Rehabilitation]. / Psychologische Kennwerte und BMI-SDS bei Jugendlichen mit Adipositas und unterschiedlichen Motivationsstadien in der stationären Rehabilitation.

PURPOSE: Obesity is strongly represented in adolescents, showing a high persistency until adulthood. Previous studies displayed short term effects of inpatient rehabilitation, but failed to demonstrate sustainability. Long-term effects might be expected when taking the motivational stage of adolescents into account. However, there is no evidence regarding motivational stages in obese adolescents in German inpatient rehabilitation. The current study investigated psychological measures and the Body-Mass-Index-standard deviation score (BMI-SDS) in obese adolescents related to motivational stages and age. METHODS: A total sample of n=127 adolescents were included in this cross-sectional study during their inpatient rehabilitation intake. Differences in BMI-SDS and self-reported psychological health were analyzed using 2-way analysis of covariance with the factors motivational stage (intender vs. actor) and age (12-14 vs. 15-17 years), and the covariate gender. Motivational stages were assessed using the newly developed questionnaire to classify motivational stages (Fragebogen zur Einteilung in Motivationsstadien; MoS). RESULTS: Intenders reported unfavorable disease management and volitional parameters. Younger participants reported a lower BMI-SDS as well as lower motivational and volitional parameters. A risk profile emerged for younger intenders which was characterized by psychological problems. CONCLUSION: The results provide important insights for the design of motivational stage-based training programs and underpin the need for age-specific therapies during adolescence.

[Healthy Siblings of Children with Autism Spectrum Disorders. A Mixed-methods Pilot Study]. / Gesunde Geschwister von Kindern mit Autismus-Spektrum-Störungen ­ Eine Mixed-Methods-Pilotstudie.

Healthy Siblings of Children with Autism Spectrum Disorders. A Mixed-methods Pilot Study Healthy siblings of chronically ill and/or disabled children may have an increased risk of developing behavioral problems; this is particularly given for siblings of children with Autism Spectrum Disorders (ASD). Quality of life and distress of five siblings (12-15 years) of children with ASD were examined using self- and parent-proxy-reports. Guideline-based interviews were conducted with the siblings and their parents and analyzed according to Mayring. Quality of life described by the children resembled the KINDLR´s standardized range of scores, but parents described a decreased quality of life. Both siblings and parents reported low to medium distress. Interviews revealed healthy children are asked by their parents to take responsibility for their siblings with ASD. Parents assumed their healthy children are less affected by the ASD of the sibling. The healthy siblings described being "annoyed" by ASD-associated behavior and partly feeling "treated unfairly". They wished their sibling no longer "suffered" from ASD or behaved "normally". The results of this pilot study, albeit with a small sample, show siblings do experience low to medium burden. This burden is often caused by the sibling relationship or the ASD-associated behavior. Suggestions for supporting the healthy siblings are given.