Specific job-anxiety in comparison to general psychosomatic symptoms at admission, discharge and six months after psychosomatic inpatient treatment

Objective: Job-anxiety is a severe problem in many patients with chronic mental disorders, as it is usually resulting in specific participation problems at the workplace and long-term sick leave. The aim of this study is to explore the development of sick leave in dependence of general psychosomatic complaints and job-anxiety from admission to a psychosomatic inpatient treatment until six months after discharge. Method: A convenience sample of 91 patients, suffering from multiple mental disorders filled in self-rating questionnaires on job-anxiety (Job-Anxiety-Scale JAS) and on general psychosomatic symptom load (Symptom Checklist SCL-90-R) at the beginning, the end, and six months after discharge from an inpatient psychosomatic treatment. Additionally, sick leave status and employment status before and six months after the treatment were assessed. Results: 15.4% of 91 patients were on sick leave before inpatient treatment and at follow-up (SS), 20.9% were fit for work at intake and follow-up (FF), 6.6% fit for work initially and on sick leave later (FS), and 57.1% on sick leave first and working at follow-up (SF). In regard to general psychosomatic complaints there are initially high scores on the SCL, a marked reduction during inpatient treatment, and a bouncing back to initial levels at follow-up for all four patient groups. SS and FS patients show the highest scores at intake and follow-up. Concerning job-anxiety, SS patients have the highest scores at all three assessments, while FF patients have significantly lower scores, with only low variation between assessments. SF patients start with comparatively high scores of job-anxiety, which even increase before reentering work, but decrease in the follow-up period when they are confronted with work again. FS patients start low like the FF patients at intake, reduce their job-anxiety further till discharge but increase to higher scores at follow-up. Conclusions: General psychosomatic symptom load and job-anxiety show a different course during treatment and are differently related to sick leave. General psychosomatic symptom load can be understood as a measure for the degree of the chronic illness status, whereas job-anxiety reflects specific additional context-related problems, i.e. problems with work. A core finding is that job-anxiety is related to work avoidance, but work exposure may reduce job-anxiety. This has direct consequences for putting patients on sick leave or not.