The project Early Intervention at the Workplace (friaa) is funded by the Federal Ministry of Education and Research (BMBF) with the funding number: BMBF-01GX1902 and is being implemented over a period of 4 years.

A total of 8 cooperation partners across Germany are involved in the friaa project. The aim of friaa is to develop and manualize a modularized work-related psychotherapeutic intervention.  

The aim of the intervention is to reach employees with psychological stress as early as possible in order to provide them with work-related psychotherapy. One of the goals of work-related psychotherapy is, if possible, to ensure that people remain in employment or to facilitate the return to work. In addition to the extraordinarily early intervention, a special feature is the networking of prevention, acute care and rehabilitation to care for mentally ill employees.

The intervention will be conducted at five locations (Berlin/Teltow, Düsseldorf, Erlangen, Hildesheim and Ulm). The intervention will be publicized through various regional networks, such as chambers of industry and commerce and company doctors. A total of almost 520 people from small, medium and large companies from as many different sectors as possible are to be recruited to participate in the intervention. The Institute for Medical Biometry and Computer Science at Heidelberg University Hospital will act as a cooperation partner to ensure that the highest standards of clinical studies are maintained. In addition to the clinical evaluation of the intervention, a health economic evaluation of the intervention will be conducted by the Department of Psychiatry and Psychotherapy II (Günzburg/Ulm), and a formative evaluation by the Federal Institute for Occupational Safety and Health (BAuA, Berlin).

Cooperation partners:

-Clinic for Psychosomatic Medicine and Psychotherapy at Ulm University Hospital, overall study management and study coordination

- Institute for Occupational, Social and Environmental Medicine at the University of Düsseldorf, co-director of the study

- Department of Psychiatry and Psychotherapy II, Günzburg

- Department of Psychosomatics and Behavior Therapy, Rehabilitation Center Seehof and Research Group Psychosomatic Rehabilitation of Charité - Universitätsmedizin Berlin

- Federal Institute for Occupational Safety and Health, Berlin

- Institute for Psychology at the University of Hildesheim

- Institute for Medical Biometry and Computer Science at the University of Heidelberg

- Psychosomatic and Psychotherapeutic Department of the University Hospital Erlangen

 

Pre-publications

Barrech A, Kilian R, Rottler E et al. (2018) Do Working Conditions of Patients in Psychotherapeutic Consultation in the Workplace Differ from Those in Outpatient Care? Results from an Observational Study. International Journal of Environmental Research and Public Health 15:227.

Bode K, Wunsch E-M, Finger F et al. (2016) Interdisziplinäre Versorgung von Arbeitnehmern mit psychischen Störungen: Ein Faktencheck am Beispiel des Salzgitter-Modells. Psychotherapie Psychosomatik Medizinische Psychologie 66:235-241.

BAuA (2018) Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit 2016 [Online] Available: www.baua.de/DE/Themen/Arbeitswelt-und-Arbeitsschutz-im-Wandel/Arbeitsweltberichterstattung/Kosten-der-AU/pdf/Kosten-2016.pdf;jsessionid=C5DA682F66AB0BE52BB51641D56BD26B.s1t1;

Bode K, Maurer F, Kröger C (2017) Arbeitswelt und psychische Störungen. Hogrefe Verlag, Göttingen.

Broda M, Hildebrand G, Köllner V (2013) Versorgungsstrukturen und Schnittstellen psychotherapeutischer Versorgung. In: Senf W, Broda M, Wilms B (Hg.), Techniken der Psychotherapie, Thieme, Stuttgart, p 312-320.

Erim Y, Toker M, Aygün S et al. (2010) Essener Leitlinien zur interkulturellen Psychotherapie. Psychotherapie im Dialog 11:299-305.

Gantner M, Brandner S, Schneider J et al. (2018) Effekte einer Psychosomatischen Betriebsambulanz auf die Arbeitsunfähigkeitszeiten der Teilnehmer - eine Analyse anhand von Sekundärdaten. In: Psychosomatik als Perspektive. 21.-24. März 2018 Berlin, Deutscher Kongress für Psychosomatische Medizin und Psychotherapie, Berlin.

Köllner V (2018) Positionspapier der DGPPR zur Medizinisch-beruflichen Rehabilitation (MBOR) in der Psychosomatik. Ärztliche Psychotherapie Im Druck.

Köllner V, Hildenbrand G, Gündel H (2018) Psychosomatische Rehabilitation – Unterschiede zur Krankenhausbehandlung und Differentialindikation. Ärztliche Psychotherapie und Psychosomatische Medizin 13:6-15

Kröger C, Bode K, Wunsch E-M et al. (2015) Work-related treatment for major depressive disorder and incapacity to work: Preliminary findings of a controlled, matched study. Journal of Occupational Health Psychology 20:248-258.

Morawa E, Erim Y (2014) Acculturation and depressive symptoms among Turkish immigrants in Germany. International Journal of Environmental Research and Public Health 11:9503-9521.

Morawa E, Erim Y (2014) Zusammenhang von wahrgenommener Diskriminierung mit Depressivität und gesundheitsbezogener Lebensqualität bei türkisch- und polnischstämmigen Migranten. Psychiatrische Praxis 41:200-207.

Roick C, Kilian R, Matschinger H et al. (2001) Die deutsche Version des Client Sociodemographic and Service Receipt Inventory - Ein Instrument zur Erfassung psychiatrischer Versorgungskosten. Psychiatrische Praxis 28:84-90.

Rothermund E, Gündel H, Kilian R et al. (2014) Behandlung psychosomatischer Beschwerden im Arbeitskontext - Konzept und erste Daten. Zeitschrift für Psychosomatische Medizin und Psychotherapie 60:177-189.

Rothermund E, Gündel H, Rottler E et al. (2016) Effectiveness of psychotherapeutic consultation in the workplace: a controlled observational trial. BMC Public Health 16.

Rothermund E, Kilian R, Rottler E et al. (2017) Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial. PLOS ONE 12:e0169559.

Rothermund E, Michaelis M, Jarczok M et al. (2018) Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions. International Journal of Environmental Research and Public Health 15:278.

Salize H-J, Kilian R (2010) Gesundheitsökonomie in der Psychiatrie. Kohlhammer, Stuttgart.

Stegmann R, Schröder U (2016) Psychische Erkrankungen in der Arbeitswelt : Wiedereingliederung nach einer psychischen Krise. Arbeitsmedizin Sozialmedizin Umweltmedizin 51:660-668.

Wege N, Angerer P (2013) Psychische Erkrankungen - Auswirkungen auf die Arbeitsfähigkeit und Versorgung psychisch erkrankter Erwerbstätiger. Die Psychiatrie 10:71-81.

previous projects

Rothermund, Eva; Klinik für Psychosomatische Medizin und Psychotherapie, Universität Ulm: Die Psychosomatische Sprechstunde im Betrieb - Ein neues Versorgungsmodell an der Schnittstelle zwischen betriebsärztlicher Betreuung und Konsiliarpsychosomatik. Förderung durch die Nachwuchsakademie Versorgungsforschung Baden-Württemberg 2011-2017. 

Scientific background

Mental illnesses are the most common reason for pensions due to reduced earning capacity and cause, due to their frequency and a comparatively low average age (around 49 years) at the start of retirement, high social costs [1, p. 42]. One reason is excessively long phases of untreated illness - due to delayed indication, long waiting times for outpatient therapy, delayed initiation of rehabilitation measures or lack of coordination between the “health actors” such as company doctors (BA), psychotherapists and rehabilitation clinics [2]. Internationally, the effectiveness of early detection and early intervention in employees with mental illnesses has not been well described or studied [3]. More recent work on intervention models in the field of early intervention often comes from Germany [4-9]. The model of "Psychosomatic Consultation Hours in the Company" (PSiB), on which this project is based, is a company-related supply network [10] for working people with psychological or psychosomatic complaints. It offers low-threshold psychotherapeutic counseling and if necessary a treatment offer is made. Initial results from our own research indicate that employees with PSiB can be reached early in the course of the disease [8; 11] and prevent periods of incapacity for work [12]. If it is possible to treat people early in the course of the disease, the prognosis and treatment outcome improve [13].

With regard to the effectiveness of interventions to improve the RTW in the mentally ill, several meta-analyzes have been published internationally. The main result is that interventions that take place outside of the workplace have no positive effect on improving the RTW [14]. However, interventions that initiate a change in the workplace with the involvement of the sick person and a representative of the employer prove to be effective with regard to short-term RTW [15]. The chances of a successful RTW are increased especially by interventions in which work-related elements such as changes in the workplace can be combined with symptom-related clinical treatment [16-18]. Here, too, cooperation between specialist disciplines and sectors is a success factor [19; 20]. Our own studies in Germany show that even an outpatient psychotherapeutic treatment that integrates the subject of work and workplace into every treatment phase favors a successful RTW compared to psychotherapy without special work aspects [21]. The occupational rehabilitation measures introduced in psychosomatic rehabilitation have also proven to be successful [22]. In outpatient and acute inpatient psychotherapy, however, the relevance to work plays too little role [23]. Based on these results and the expertise gathered by the project partners, we designed the “modular work-related psychotherapy”. It combines early detection and early intervention, work-related psychotherapy [21; 24], psychotherapeutic accompaniment at RTW and work-related psychosomatic rehabilitation under a uniform psychotherapeutic concept. The implementation of the MAP concept is based on the “psychosomatic consultation hours in the company” (PSiB) care model. The individual building blocks have been examined in the sense of national (Memorandum III Health Services Research) [25] and international guidelines [26] for researching complex interventions with regard to theoretical background, context factors, feasibility, effectiveness under routine conditions, sometimes also under randomized conditions.

Despite high international productivity losses due to depression and other mental disorders [27], there are so far only a few methodologically adequate studies on the health-economic assessment of workplace-related measures for the primary and secondary prevention of mental illnesses [28-30].

 

[1] Deutsche Rentenversicherung Bund (Hg.) (2018) Statistik der Deutschen Rentenversicherung - Rente 2016. Deutsche Rentenversicherung Bund, Berlin.

[2] Broda M, Hildebrand G, Köllner V (2013) Versorgungsstrukturen und Schnittstellen psychotherapeutischer Versorgung. In: Senf W, Broda M, Wilms B (Hg.), Techniken der Psychotherapie, Thieme, Stuttgart, p 312-320.

[3] Dietrich S, Deckert S, Ceynowa M et al. (2012) Depression in the workplace: a systematic review of evidence-based prevention strategies. International Archives of Occupational and Environmental Health 85:1-11.

[4] Bode K, Wunsch E-M, Finger F et al. (2016) Interdisziplinäre Versorgung von Arbeitnehmern mit psychischen Störungen: Ein Faktencheck am Beispiel des Salzgitter-Modells. Psychotherapie Psychosomatik Medizinische Psychologie 66:235-241.

[5] Burman-Roy S, Butterworth M, Madan I et al. (2013) Which patients are seen by an occupational psychiatry service?. Occupational Medicine-oxford 63:507-9.

[6] Mayer D, Schmidt H, Hoelzer M (2010) Psychosomatische Sprechstunde und Psychosomatische Grundversorgung in der Arbeitsmedizin. Arbeitsmed Sozialmed Umweltmed 45:593-597.

[7] Rothermund E, Gündel H, Kilian R et al. (2014) Behandlung psychosomatischer Beschwerden im Arbeitskontext - Konzept und erste Daten. Zeitschrift für Psychosomatische Medizin und Psychotherapie 60:177-189.

[8] Rothermund E, Kilian R, Rottler E et al. (2017) Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial. PLOS ONE 12:e0169559.

[9] Rothermund E, Michaelis M, Jarczok M et al. (2018) Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions. International Journal of Environmental Research and Public Health 15:278.

[10] Wege N, Angerer P (2013) Psychische Erkrankungen - Auswirkungen auf die Arbeitsfähigkeit und Versorgung psychisch erkrankter Erwerbstätiger. Die Psychiatrie 10:71-81.

[11] Barrech A, Kilian R, Rottler E et al. (2018) Do Working Conditions of Patients in Psychotherapeutic Consultation in the Workplace Differ from Those in Outpatient Care? Results from an Observational Study. International Journal of Environmental Research and Public Health 15:227.

[12] Gantner M, Brandner S, Schneider J et al. (2018) Effekte einer Psychosomatischen Betriebsambulanz auf die Arbeitsunfähigkeitszeiten der Teilnehmer - eine Analyse anhand von Sekundärdaten. In: Psychosomatik als Perspektive. 21.-24. März 2018 Berlin, Deutscher Kongress für Psychosomatische Medizin und Psychotherapie, Berlin.

[13] Cosci F, Fava GA (2012) Staging of Mental Disorders: Systematic Review. Psychotherapy and Psychosomatics 82:20-34.

[14] Vogel N, Schandelmaier S, Zumbrunn T et al. (2017) Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database of Systematic Reviews Art. No.: CD011618.

[15] van Vilsteren M, van Oostrom SH, de Vet HC et al. (2015) Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database of Systematic Reviews Art. No.: CD006955.

[16] Nieuwenhuijsen K, Faber B, Verbeek JH et al. (2014) Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews Art. No.: CD006237.

[17] Reme SE, Grasdal AL, Løvvik C et al. (2015) Work-focused cognitive-behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial. Occupational and Environmental Medicine 72:745-752.

[18] Joyce S, Modini M, Christensen H et al. (2016) Workplace interventions for common mental disorders: a systematic meta-review. Psychological Medicine 46:683-697.

[19] Vlasveld MC, van der Feltz-Cornelis CM, Adèr HJ et al. (2012) Collaborative care for major depressive disorder in an occupational healthcare setting. The British Journal of Psychiatry 200:510-1.

[20] Vlasveld MC, Van der Feltz-Cornelis CM, Adèr HJ et al. (2013) Collaborative care for sick-listed workers with major depressive disorder: A randomised controlled trial from the netherlands depression initiative aimed at return to work and depressive symptoms. Occupational and Environmental Medicine 70:223-230.

[21] Kröger C, Bode K, Wunsch E-M et al. (2015) Work-related treatment for major depressive disorder and incapacity to work: Preliminary findings of a controlled, matched study. Journal of Occupational Health Psychology 20:248-258.

[22] Beutel ME, Zwerenz R, Bleichner F et al. (2005) Vocational training integrated into inpatient psychosomatic rehabilitation textendash short and long-term results from a controlled study. Disability and Rehabilitation 27:891-900.

[23] Alsdorf N, Engelbach U, Flick S et al. (2017) Psychische Erkrankungen in der Arbeitswelt. transcript Verlag, Bielefeld.

[24] Plinz N, Unger H-P (2013) Eine alte Antwort auf neue Fragen Die Entwicklung des Behandlungskonzeptes der Tagesklinik für Stressmedizin an der Asklepios Klinik Hamburg Harburg. Verhaltenstherapie & psychosoziale Praxis 45:345-353.

[25] Pfaff H, Glaeske G, Neugebauer EAM et al. (2009) Memorandum III: Methoden für die Versorgungsforschung (Teil I). Das Gesundheitswesen 71:505-510.

[26] Craig P, Dieppe P, Macintyre S et al. (2006) Developing and evaluating complex interventions: new guidance. Medical Research Council, London.

[27] Evans-Lacko S, Knapp M (2016) Global patterns of workplace productivity for people with depression: absenteeism and presenteeism costs across eight diverse countries. Social Psychiatry and Psychiatric Epidemiology 51:1525-1537.

[28] Hamberg-van Reenen HH, Proper KI, van den Berg M (2012) Worksite mental health interventions: a systematic review of economic evaluations. Occupational and Environmental Medicine 69:837-845.

[29] van Oostrom SH, Anema JR, Terluin B et al. (2008) Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial. BMC Public Health 8.

[30] Rebergen DS, Bruinvels DJ, van Tulder MW et al. (2009) Cost-Effectiveness of Guideline-Based Care for Workers with Mental Health Problems. Journal of Occupational and Environmental Medicine 51:313-322.