Institute of General Practice, Klinikum rechts der Isar der Technischen Universität München; Institute of Psychological Methods and Diagnostics, Department of Psychology, Ludwig-Maximilians-Universität München; Faculty for Psychology, Pedagogy and Sport Science, University of Regensburg; Clinic and Polyclinic for Psychiatry and Psychotherapy, Technische Universität München; Institute of Psychology, University of Innsbruck, Austria; Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, Universitätsklinikum Hamburg Eppendorf.
Dtsch Arztebl Int. 2017 Apr 28;114(17):291-297. doi: 10.3238/arztebl.2017.0291.
In this cross-sectional study, we aimed to determine the relation between sick leave duration, burnout symptoms, depression, anxiety, and somatization in a primary care setting.
Patients receiving a sickness certificate in one of 14 participating primary care practices were consecutively asked by their primary care physician to fill in a questionnaire comprising the Maslach Burnout Inventory-General Survey (MBI-GS) and the Patient Health Questionnaire (PHQ) containing the depression (PHQ-9), somatization (PHQ-15), and anxiety (GAD-7) scales. The main diagnosis on the sickness certificate was documented by the issuing physician. A quasi-Poisson regression analysis was performed to estimate the influence of burnout symptoms, depression, and anxiety on length of sick leave.
225 patients participated, 122 (54.2%) were female; the mean age was 39.5 years. Length of sick leave correlated with emotional exhaustion (p = 0.005), depersonalization (p = 0.013), depression (p = 0.006), anxiety (p = 0.023), and somatization (p = 0.001). However, regression analysis revealed that the only predictors for length of sick leave were anxiety (exp[0.081] = 1.084; p = 0.013), age (exp[0.017] = 1.017; p = 0.041) and education (exp[- 0.508] = 0.602; p = 0:029). The pseudo R2 of the model was 0.25.
The impact of anxiety on burnout symptoms and sick leave days might have been underestimated so far. A holistic approach in patient centered communication should comprise the evaluation of psychosomatic comorbidity under consideration of the established concepts of depression and anxiety disorder to ensure adequate diagnostic and therapeutic management.
在这项横断面研究中，我们旨在确定初级保健环境中病假持续时间、倦怠症状、抑郁、焦虑和躯体化之间的关系。
在参与的 14 家初级保健实践中，由初级保健医生连续向接受病假证明的患者询问一份问卷，该问卷包括 Maslach 倦怠量表-一般调查（MBI-GS）和包含抑郁（PHQ-9）、躯体化（PHQ-15）和焦虑（GAD-7）的患者健康问卷。签发医生记录病假证明上的主要诊断。进行拟泊松回归分析以估计倦怠症状、抑郁和焦虑对病假长度的影响。
225 名患者参与，122 名（54.2%）为女性；平均年龄为 39.5 岁。病假长度与情绪疲惫（p = 0.005）、去人格化（p = 0.013）、抑郁（p = 0.006）、焦虑（p = 0.023）和躯体化（p = 0.001）相关。然而，回归分析显示，病假长度的唯一预测因素是焦虑（exp[0.081] = 1.084；p = 0.013）、年龄（exp[0.017] = 1.017；p = 0.041）和教育（exp[-0.508] = 0.602；p = 0.029）。该模型的伪 R2 为 0.25。
迄今为止，焦虑对倦怠症状和病假天数的影响可能被低估了。以患者为中心的沟通中的整体方法应包括评估身心共病，同时考虑到抑郁和焦虑障碍的既定概念，以确保进行充分的诊断和治疗管理。
