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254 Pages·2008·1.6 MB·English
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Workplace-related anxieties and workplace phobia A concept of domain-specific mental disorders This work is licensed under a Creative Commons License: Attribution - Noncommercial - Share Alike 2.0 Germany To view a copy of this license visit http://creativecommons.org/licenses/by-nc-sa/2.0/de/ Online published at the Institutional Repository of the Potsdam University: http://opus.kobv.de/ubp/volltexte/2008/2004/ urn:nbn:de:kobv:517-opus-20048 [http://nbn-resolving.de/urn:nbn:de:kobv:517-opus-20048] UNIVERSITY OF POTSDAM Faculty of Human Sciences, Department of Psychology DOCTORAL THESIS WORKPLACE-RELATED ANXIETIES AND WORKPLACE PHOBIA A CONCEPT OF DOMAIN-SPECIFIC MENTAL DISORDERS for achieving the academic degree of Doctor of Philosophy (Dr. Phil.) Dipl.-Psych. Beate Muschalla January 2008 First Consultant: Prof. Dr. Uwe Schaarschmidt Second Consultant: Prof. Dr. Michael Linden Date of oral examination: 12.08.2008 ACKNOWLEDGEMENTS I am very grateful to Prof. Dr. Uwe Schaarschmidt for continuously supervising my thesis in uncomplicated communication and for helpful advice. I also want to thank Prof. Dr. Michael Linden for the opportunity to carry out this research study in the Rehabilitation Center Seehof, and more over for the exciting debates he patiently fought out with me about this work and issues beyond. 2 TABLE OF CONTENTS List of Tables..............................................................................................................................6 List of Figures............................................................................................................................8 Abstract......................................................................................................................................9 1 Introduction...........................................................................................................................11 2 Theoretical Background: Workplace and Anxiety................................................................14 2.1 State of Research.........................................................................................................................14 2.2 Workplace-related Anxieties: A Complex and Heterogeneous Phenomenon.............................18 2.2.1 Different Qualities of Workplace-related Anxieties...........................................................................20 2.2.2 Workplace Phobia...............................................................................................................................24 Excursus A: Workplace-related Adjustment Disorders with Other Affects.................................................28 2.3 Etiologic Perspective...................................................................................................................30 2.4 Situational Factors: Why do Workplaces provoke Anxiety?................................................. . 37 2.5 Nosologic Status of Workplace Phobia................................................................................. 41 2.6 Workplace-related Anxieties and Work Participation Disorders …….……............... 43 2.7 Therapy Interventions............................................................................................................….49 2.8 Concept of Domain-specific Mental Disorders.....................................................................…. 50 2.9 Summary of Theoretical Background and Questions of Research ..............................................52 2.9.1 Summary.............................................................................................................................................52 2.9.2 Questions of Research........................................................................................................................53 3 Methods.................................................................................................................................55 3.1 Sample.........................................................................................................................................55 3.2 Clinical Setting............................................................................................................................57 3.3 Study Design and Data Collection..............................................................................................58 3.3.1 Socio-demographic and additional Data from the Routine Diagnostic and Medical Report..............60 3.4 Instruments..................................................................................................................................62 3.4.1 Mini International Neuropsychiatric Interview (MINI)......................................................................63 3.4.2 Mini-Work-Anxiety-Interview (Mini-WAI).......................................................................................64 3.4.3 Carrying out the Diagnostic Interview (Mini-WAI and MINI)..........................................................70 3.4.4 Job-Anxiety-Scale (JAS)....................................................................................................................75 3 3.4.5 Short Questionnaire for Job Analysis (KFZA)...................................................................................77 3.4.6 Symptom Checklist (SCL-90-R)........................................................................................................78 3.4.7 Intelligence Structure Analysis (ISA).................................................................................................78 3.5 Data Analysis..............................................................................................................................79 4 Results...................................................................................................................................81 4.1 Workplace-related Anxieties and Conventional Anxiety or other Mental Disorders.................82 4.2 Conventional Mental Disorders and their Comorbidities...........................................................84 4.3 Different Qualities of Workplace-related Anxieties and their Comorbidities............................88 4.4 Comorbidities between Workplace-related Anxieties and Conventional Mental Disorders.......93 4.5 Workplace-related Anxieties and Work Participation Disorders ...............................................98 4.6 Correlates of Workplace-related Anxieties...............................................................................105 4.6.1 Clustering Participants into Homogeneous Groups..........................................................................115 Excursus A: Workplace-related Anxieties and Workplace-related Adjustment Disorders with Other Affects...................................................................120 4.7 Etiologic Perspective.................................................................................................................126 4.8 Work-specific Therapy Interventions.......................................................................................130 4.9 Workplace Phobia.....................................................................................................................137 4.10 Summary of Results: Answering Questions of Research........................................................142 5 Discussion...........................................................................................................................145 5.1 Workplace-related Anxieties: Different from Conventional Anxiety Disorders?.....................145 5.2 Conventional Mental Disorders: Their Interrelations and Comorbidities.................................147 5.3 Different Qualities of Workplace-related Anxieties: Their Interrelations and Comorbidities..149 5.4 Comorbidities between Workplace-related Anxieties and Conventional Mental Disorders.....154 5.5 Workplace-related Anxieties and Work Participation Disorders..............................................160 5.6 Correlates of Workplace-related Anxieties................................................................................164 5.6.1 Situational Factors: Why do Workplaces provoke Anxiety?............................................................164 5.6.2 Other Correlates of Workplace-related Anxieties.............................................................................170 5.6.3 Risk Factors for Job-Anxiety and Work Participation Disorders: Interpreting Homogeneous Groups of Participants...........................................................................174 4 Excursus A: Workplace-related Anxieties and Workplace-related Adjustment Disorders with Other Affects...................................................................177 Excursus B: Case Vignettes of Workplace Phobia and Treatment Trials - The Clinical Perspective.............................................................................................181 5.7 Etiologic Perspective.................................................................................................................186 5.8 Work-specific Therapy Interventions.......................................................................................187 5.9 Workplace Phobia: Concept of a Domain-specific Mental Disorder and Nosologic Status ... 191 5.10 Study Design, Instruments and Sample..................................................................................199 5.11 Limitations of the Study..........................................................................................................204 6 Conclusion......................................................................................................................….208 7 References...........................................................................................................................210 8 Glossary of Terminology....................................................................................................221 9 Appendix.............................................................................................................................228 A Mini-Work-Anxiety-Interview (Mini-WAI) B Job-Anxiety-Scale (JAS) "Questionnaire on Workplace-Problems" including the "Short Questionnaire for Job Analysis" (KFZA) 5 LIST OF TABLES Table 1. Differential diagnosis of workplace-related anxieties and workplace phobia.......22/23 Table 2. Diagnostic criteria of Specific Phobia (300.29) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)........................................26 Table 3. Differential diagnosis of workplace-related adjustment disorders.............................29 Table 4. Socio-demographic data and characteristics of the occupational situation in the sample of psychosomatic inpatients.................................................................56 Table 5a+b. The leading questions of anxiety diagnosis in the MINI International Neuropsychiatric Interview (MINI) and the Mini-Work-Anxiety-Interview (Mini-WAI) .........................................................................66/67 Table 5c. Question on work participation disorders and question on work performance disorders in the Mini-WAI......................................................69 Table 6. Main dimensions and subscales of the Job-Anxiety-Scale (JAS)...............................76 Table 7a. Comorbidities of workplace-related anxieties and conventional anxiety disorders according to Mini-WAI and MINI in psychosomatic inpatients..................82 Table 7b. Comorbidities of workplace-related mental disorders and conventional mental disorders (including anxiety disorders) according to Mini-WAI and MINI in psychosomatic inpatients .................................................................84 Table 8. Comorbidities of conventional anxiety and adjustment disorders according to MINI in psychosomatic inpatients suffering from mental disorders....................86 Table 9. Levels of general psychosomatic symptom load in different dimensions according to the Symptom Checklist (SCL-90-R) in psychosomatic inpatients.......................87 Table 10. Comorbidities of workplace-related anxieties according to the Mini-WAI in psychosomatic inpatients .............................................................................91 Table 11. Levels of job-anxiety in different dimensions according to the JAS in psychosomatic inpatients in the beginning of rehabilitation ....................................................92 Table 12. Comorbidities of workplace-related anxieties and conventional mental disorders according to MINI and Mini-WAI in psychosomatic inpatients ..............................97 Table 13a. Work participation disorders according to Mini-WAI and sick leave duration in psychosomatic inpatients ......................................................................98 Table 13b. Work participation disorders and work performance disorders in 6 psychosomatic inpatients with workplace-related mental disorders according to Mini-WAI ..........................................................................................................100 Table 13c. Work performance disorders in psychosomatic inpatients with workplace-related mental disorders according to Mini-WAI ........................................101 Table 13d. Work participation disorders with absence from work in psychosomatic inpatients with workplace-related disorders according to Mini-WAI ......102 Table 14. Profiles of anxiety diagnosis according to MINI and Mini-WAI and duration of sick leave in psychosomatic inpatients .........................................................104 Table 15. Workplace-related anxieties and general psychosomatic symptom load: Differences between male and female psychosomatic inpatients ..........................................105 Table 16. Workplace characteristics according to the Short Questionnaire for Job Analysis (KFZA) reported by psychosomatic inpatients .........108 Table 17a. Correlations between symptom load (SCL Global Severety Index, JAS mean score) and experienced workplace conditions (KFZA) in psychosomatic inpatients ...................................................................................................110 Table 17b. Correlations between hours of work, overtime, experienced work load and experienced workplace conditions (KFZA) in psychosomatic inpatients ..............................110 Table 18. Correlations between dimensions of job-anxiety (JAS) and general psychosomatic symptom load (SCL-90-R) in psychosomatic inpatients ..............................111 Table 19. Correlations between symptom load (JAS, SCL) and sick leave, work load, professional degree and cognitive fitness (Intelligence Structure Analysis, ISA) in psychosomatic inpatients .......................................................................................................113 Table 20a. Two-Step-Cluster-Analysis with the variables professional status, pattern of diagnosis as stated in the interview, work participation disorder (in its severest appearance) resulting from any workplace-related anxiety or workplace-related adjustment disorder, current professional domain, gender, age and job-anxiety level (JAS) in psychosomatic inpatients ................................................................................................................................116 Table 20b. Workplace-related anxieties, experienced work load, sick leave duration and cognitive fitness in psychosomatic inpatients according to the cluster groups.......................118 Table 21. Self-reported general psychosomatic symptom load (SCL-90-R) and dimensions of job-anxiety (JAS) in psychosomatic inpatients according to different diagnostic pattern.................................................................................124 Table 22a+b. Self-reported general psychosomatic symptom load (SCL-90-R) and dimensions of job-anxiety (JAS) in psychosomatic inpatients according to different etiology pattern ............................................................................128/129 Table 23. General and job-related symptom load, workplace phobia, work load and sick leave in psychosomatic inpatients 7 according to participation in work-specific therapies ............................................................132 Table 24a. Self-reported general psychosomatic symptom load (SCL-90-R), dimensions of job-anxiety (JAS) and sick leave in psychosomatic inpatients according to participation in work-specific group therapies...................................................134 Table 24b. Workplace-related anxieties according to Mini-WAI and work load in psychosomatic inpatients according to participation in work-specific group therapies.........135 Table 25. Occupational situation, return to work, participation in work-specific therapy, fitness for work in beginning and end of rehabilitation in psychosomatic inpatients according to diagnosis pattern.................................................................................................136 Table 26. Self-reported general psychosomatic symptom load (SCL-90-R) and dimensions of job-anxiety (JAS) in psychosomatic inpatients according to diagnosis pattern: workplace-related anxiety – workplace phobia....................141 LIST OF FIGURES Figure 1. Etiology of workplace phobia....................................................................................31 Figure 2. Diagnosis of conventional mental disorders according to the Mini International Neuropsychiatric Interview (MINI) in psychosomatic inpatients ......................85 Figure 3. Distribution of workplace-related anxieties assessed with the Mini-Work-Anxiety-Interview (Mini-WAI) in psychosomatic inpatients ................................89 Figure 4. Workplace-related anxieties according to Mini-WAI in different professional groups of psychosomatic inpatients ................................................107 Figure 5. Comorbidities of workplace-related anxieties and adjustment disorders in psychosomatic inpatients according to Mini-WAI.............................................................121 8

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4.2 Conventional Mental Disorders and their Comorbidities . 5.3 Different Qualities of Workplace-related Anxieties: Their Interrelations and
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