[Diagnostic instruments for occupational stress experience and coping in psychosomatic rehabilitation].
BACKGROUND
Psychosomatic rehabilitation research increasingly agrees that symptom-related therapies need to be supplemented by work-related therapeutic interventions. However, there is a lack of evaluated diagnostic instruments for determination of an indication for and evaluation of specific work-related interventions. This article presents an analysis of the diagnostic quality of work-related self-rating instruments as well as their evaluation from a practical perspective.


METHODS
281 psychosomatic inpatients showing high levels of occupational stress were studied using a set of work-related questionnaires on admission: individual coping skills (AVEM), work-related therapy motivation (FBTM), work satisfaction (ABB), leisure activities, experienced control at work, as well as occupational concerns and social stressors at work. Furthermore a sub-group of 78 patients who had completed a specific work-related group programme during their inpatient treatment were interviewed three months post-treatment. The instruments used were examined for reliability, underlying dimensions (factor analysis), health relevance (correlations with the SCL-90-R total score GSI as health-related external criterion), and sensitivity to change.


RESULTS
(1) Reliability: Measuring procedures fulfilled the requirements of measurement accuracy. (2) Underlying dimensions: Factor-analytical investigations of relevant occupational constructs identified six aspects of occupational coping relevant for rehabilitation practice: "occupational resilience", "occupational (over-)commitment", "occupational gratification", "well-being at work", a motivational factor of "occupational identification vs. withdrawal", and "leisure activities". (3) Health relevance: Variables of "occupational resilience" and "occupational gratification" showed the highest correlations with indicators of psychosomatic health. (4) Sensitivity to change: Work-related instruments proved to be predominantly sensitive to change.


CONCLUSIONS
The work-related self-report instruments proved satisfactorily in application with psychosomatic patients. The findings concerning their diagnostic quality show that they can be recommended in research to evaluate work-related issues. Longitudinal evaluations should include work-related diagnostic instruments to a much larger extent.
Koch
S
S
Medizinisch-Psychosomatische Klinik Roseneck, Prien am Chiemsee. skoch@schoen-kliniken.de
Hillert
A
A
Geissner
E
E
D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D012050:Rehabilitation, Vocational / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications* / Q000175:diagnosis / Q000523:psychology